Asunto(s)
Circulación Sanguínea , Hemodinámica , Modelos Cardiovasculares , Venas/fisiología , Animales , HumanosRESUMEN
OBJECT: A review of the literature has revealed scant data related to neurosurgical treatment of gravid patients. The authors reviewed their experience with the neurosurgical treatment of pregnant women to better characterize the optimal management strategies for intracranial pathological entities in this population. METHODS: Between July 1969 and July 2005, 34 patients with documented pregnancy and concomitant intracranial pathological entities were treated at the authors' institution. The average age of the gravid patients at presentation was 27 +/- 6 years. Twelve patients harbored vascular and 14 patients harbored neoplastic lesions. Four gravid patients suffered from traumatic intracranial hemorrhage, 2 had primary intracerebral hemorrhage, and 2 had hydrocephalus. The medical records of these patients were reviewed to assess the outcome for the mothers and fetuses. RESULTS: Nineteen pregnant patients (56%) underwent a neurosurgical procedure after induction of general anesthesia. Of these, 14 (74%) underwent craniotomies for clipping/resection of their lesion, 2 (10%) underwent stereotactic biopsies, and 3 (16%) underwent CSF shunting procedures. Three patients (9%) delivered by cesarean section followed by their neurosurgical procedure, and 5 (15%) underwent therapeutic abortion preoperatively to allow for radiation therapy early in their pregnancy (4 of these patients underwent surgery prior to their therapeutic abortion). Eleven patients (32%) were treated nonoperatively while pregnant, and 3 of these received their treatment after delivery. There was no operative maternal mortality or permanent morbidity. The fetuses did not suffer from any complications related to the mother's neurosurgical procedure. CONCLUSIONS: Based on the authors' experience and a review of the literature, surgery for intracranial lesions in pregnant patients is generally well tolerated by both mother and fetus. Preoperative delivery by cesarean section of term or near-term babies is reasonable. Some patients treated conservatively may deteriorate and require an operation.
Asunto(s)
Encéfalo/cirugía , Procedimientos Neuroquirúrgicos/métodos , Complicaciones del Embarazo/cirugía , Adolescente , Adulto , Encéfalo/patología , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Trastornos Cerebrovasculares/cirugía , Femenino , Humanos , Hidrocefalia/cirugía , Hemorragias Intracraneales/cirugía , Imagen por Resonancia Magnética , Embarazo , Resultado del Tratamiento , Adulto JovenRESUMEN
One of the most feared complications after intracranial surgery is development of acute intracranial pathology, which may result in hypoperfusion and brain injury. Thus, early neurological assessment, performed in the operating room immediately after emergence from anesthesia, is a practice that may contribute to timely diagnosis of neurosurgical complications. Failure to awake after general anesthesia precludes conductance of neurological assessment. We report a patient who failed to emerge from anesthesia after suboccipital craniotomy and had absent brain-stem reflexes with fixed and dilated pupils consistent with severe brain injury. Approximately 60 minutes after termination of surgery, the patient suddenly woke up. After the fact, we discovered that the neurosurgeon performed a generous field block with bupivacaine along the neck incision line. We presume that our patient's failure to awaken was caused by paralysis of brain-stem caused by migration of bupivacaine from the site of the injection.
Asunto(s)
Periodo de Recuperación de la Anestesia , Anestesia General , Anestésicos Locales/efectos adversos , Malformación de Arnold-Chiari/cirugía , Tronco Encefálico/efectos de los fármacos , Bupivacaína/efectos adversos , Craneotomía/efectos adversos , Complicaciones Posoperatorias/inducido químicamente , Reflejo Anormal , Adulto , Humanos , Inyecciones Intramusculares/efectos adversos , Masculino , Músculos del Cuello/efectos de los fármacos , Examen Neurológico/efectos de los fármacos , Hueso Occipital/cirugía , Reflejo Pupilar/efectos de los fármacos , Remisión EspontáneaRESUMEN
Venous pressures measured from peripheral venous catheters (PVP) closely estimate the central venous pressure (CVP) in surgical and critically ill patients. CVP is often used to estimate intravascular volume; however, fluctuations of CVP may also be induced by changes in venous tone caused by alpha-adrenergic catecholamine stimulation. We simultaneously monitored PVP, CVP, and mean arterial blood pressure during resection of pheochromocytoma in a 63-yr-old woman and found excellent correlation between the three pressure variables, suggesting that fluctuations of PVP reflect overall changes in vascular tone.