Risks & Complications
No surgery is risk-free. Every operation has danger of injury associated with it.
Table: Neurosurgery Operations & Risks
Risks
Agitation can be caused by increased intracranial pressure, drugs, hypoxia, fever, nausea, pain, and is exacerbated by confusion, that under certain circumstances can span a spectrum from simple disorientation to delusions or even hallucinations.
Agitation can be dangerous to the patient and staff.
Agitation management strategies can be divided into 1. behavioral and 2. pharmacologic.
Agitation can frequently be managed pharmacologically (with drugs) like Valium.
Morphine is effective when agitation results from or is exacerbated by pain.
Over-sedation is a complication of managing agitation.
The sitting position (used for operation of the lower back of the head, i.e. suboccipital) the patient’s head is above the level of the heart. In this position the pressure of blood in the larger veins that empty into the heart, such as the vena cava, is lower than the pressure in the back of the head. The difference in venous pressure creates a siphon, sucking from the head to the heart.
As veins are opened into during incision of skin, dissection through muscle, and removal of bone, air is sucked into the veins, forming bubbles that are carried from smaller to larger veins and ultimately into the vena cava and heart. The heart then pumps the bubbles into the small capillaries of the lungs where oxygen is exchanged for carbon dioxide (respiration).
Because most of the veins open into during a suboccipital surgery (as for a posterior fossa decompression of a Chiari I malformation) are small, the bubbles that form in the veins are usually microscopic.
Even small bubbles in large enough numbers can coalesce into bubbles big enough that when they lodge in the small pulmonary (lung) capillaries, blood cannot get into the capillaries and gas (oxygen and carbon) exchange cannot occur. Without gas exchange blood passes through the lungs without picking up oxygen and unloading carbon dioxide. Too little or no oxygen (hypoxia or anoxia) causes cells to stop working and even to die.
During a posterior fossa surgery with the patient in the sitting position recognition of air embolism from the operative site to the lungs require measurement and monitoring (continuous measurement over time) of physiologic parameters such as the amount of oxygen and carbon dioxide in the blood. Oxygen saturation decreases while carbon dioxide increases in the presence of an air embolism.
The likelihood of an air embolism is minimized by using positions other than sitting.
If the sitting position must be used the anesthesiologist should be monitoring end tidal CO2 the surgeons prepared at any minute to flood their field with water (stops the sucking of air into veins) and lowering the patient's head while anesthesia attempts to aspirate any bubbles that may have accumulated in the patient's heart.
A low red blood cell count (anemia) can result from blood loss during and/or after neurosurgery .
Intra-operative blood loss is most significant during spinal stabilization procedures.
Oxygen is so important to stressed brain that the oxygen carrying capacity should be optimized whenever possible by optimizing circulating oxygen-carrying hemoglobin.
At critically low hemoglobin (oxygen-carrying molecule in red blood cells) levels brain cells fail metabolically and can be permanently injured or die.
Anemia management is both preventive and active. Minimize drawing of blood (no unnecessary labs, no "routine" or "daily" labs).
Interventions to correct anemia: 1. iron (effect over several weeks) and 2. red blood cell transfusion (effect immediate).
Transfusion in Neurosurgical ICU
Formation of scar tissue in the arachnoid space.
In clinical practice “arachnoiditis” refers to scarring around one or more of the spinal nerve roots (most frequently lumbar) following surgical manipulation, as for removal of an intervertebral disc, to decompress a nerve compressed by a bulging disc (or herniated), or lamina and ligamentum flavum.
Arachnoiditis is thought to be an important factor in the majority of cases of surgical "failed back" -- chronic pain following surgery of the lumbosacral (lumbar and sacral) spine.
Collapse of the alveoli in the lungs .
Frequent complication of mechanical ventilation.
Can contribute to post op pneumonia.
Incentive spirometry, mobilization.
Bone flaps created during craniotomy do not have normal blood supply that would normally bring immune cells in to kill bacteria that might have found their way onto the bone sometime between the time it was taken from and when it was replaced.
The brain swells when mechanically traumatized by pushing, pulling, burning, etc. Increased intracranial pressure. Distortion of the brainstem. Herniation.
The brain swells when mechanically traumatized by pushing, pulling, burning, etc .
Constipation is an inability to move the bowels (defecate) for many days.
Associated with bowel paralysis with stasis of intestinal contents, interfering with normal digestion and nutrient absorption.
Can contribute to agitation, hypertension. Known risk for re-bleed of unsecured )not yet clipped) cerebral aneurysm.
Corneal abrasion is extremely painful.
Dehiscence of a wound.
Dehiscence of a wound.
Diabetes insipidus and SIADH complicate trauma or surgery to the Hypothalamus / Pituitary gland or tumors growing in or against these structures.
In clinical practice “arachnoiditis” refers to scarring around one or more of the spinal nerve roots (most frequently lumbar) following surgical manipulation, as for removal of an intervertebral disc, to decompress a nerve compressed by a bulging disc (or herniated), or lamina and ligamentum flavum.
In clinical practice “arachnoiditis” refers to scarring around one or more of the spinal nerve roots (most frequently lumbar) following surgical manipulation, as for removal of an intervertebral disc, to decompress a nerve compressed by a bulging disc (or herniated), or lamina and ligamentum flavum.
Many patients have fevers (are "febrile") in the first 24 to 48 hours following neurosurgery (brain, spine, or nerve) .
In clinical practice “arachnoiditis” refers to scarring around one or more of the spinal nerve roots (most frequently lumbar) following surgical manipulation, as for removal of an intervertebral disc, to decompress a nerve compressed by a bulging disc (or herniated), or lamina and ligamentum flavum.
The recurrent laryngeal nerves moves the vocal cords. There are two - right and left.
The nerve is not visible during dissection, retraction, and manipulation of the tissues of the front of the neck.
In clinical practice “arachnoiditis” refers to scarring around one or more of the spinal nerve roots (most frequently lumbar) following surgical manipulation, as for removal of an intervertebral disc, to decompress a nerve compressed by a bulging disc (or herniated), or lamina and ligamentum flavum.
In clinical practice “arachnoiditis” refers to scarring around one or more of the spinal nerve roots (most frequently lumbar) following surgical manipulation, as for removal of an intervertebral disc, to decompress a nerve compressed by a bulging disc (or herniated), or lamina and ligamentum flavum.
In clinical practice “arachnoiditis” refers to scarring around one or more of the spinal nerve roots (most frequently lumbar) following surgical manipulation, as for removal of an intervertebral disc, to decompress a nerve compressed by a bulging disc (or herniated), or lamina and ligamentum flavum.
In clinical practice “arachnoiditis” refers to scarring around one or more of the spinal nerve roots (most frequently lumbar) following surgical manipulation, as for removal of an intervertebral disc, to decompress a nerve compressed by a bulging disc (or herniated), or lamina and ligamentum flavum.
Moving tissue out of the way requires application of forces that can injure the tissue.
Nerve retraction
Brain retraction
Moving tissue out of the way requires application of forces that can injure the tissue.
Nerve retraction
Brain retraction
Moving tissue out of the way requires application of forces that can injure the tissue.
Nerve retraction
Brain retraction
Sedation is a state of sensorial brain dysfunction characterized by lethargy and confusion and a tendency to fall off to sleep without constant stimulation -- brought about by administration of pharmacologic (brain function depressant) agents.
SIADH
DI and SIADH complicate trauma or surgery to the Hypothalamus / Pituitary gland or tumors growing in or against these structures.
In clinical practice “arachnoiditis” refers to scarring around one or more of the spinal nerve roots (most frequently lumbar) following surgical manipulation, as for removal of an intervertebral disc, to decompress a nerve compressed by a bulging disc (or herniated), or lamina and ligamentum flavum.
When pressure is applied to places (like the superior iliac spine, or the ischial tuberosity) where the skin is thin.
In clinical practice “arachnoiditis” refers to scarring around one or more of the spinal nerve roots (most frequently lumbar) following surgical manipulation, as for removal of an intervertebral disc, to decompress a nerve compressed by a bulging disc (or herniated), or lamina and ligamentum flavum.
Iatrogenic subdural hematoma
Blood clot in one of the large veins in the leg. The blood clot can move into the lungs and interfere with respiration (gas exchange) leading to sudden death .
Many men have problems voiding (urinating) after surgery. Patients who have Foley catheters in must be reassured that the sensation of needing to void is due to the catheter in their bladder.
Vomiting is a dangerous in patients with depressed consciousness who are at risk for inhaling (aspirating) their stomach contents and developing a chemical pneumonitis that all too frequently progresses to pneumonia and/or ARDS.
A nasogastric (NG) tube is used to aspirate stomach contents.
Index
AIDS
brain abscess
coagulopathy
heart failure
hepatitis
HIV infection
hydrocephalus
hypotension
hypertension
Jacob Creutzfeld
liver failure
myocardial infarction
nerve injury
ventriculitis