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Management of Postoperative Care in Neurosurgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: closed (20 May 2025) | Viewed by 1995

Special Issue Editor


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Guest Editor
Department of Anesthesiology, Resuscitation and Critical Care, Medical Faculty, JJ Strossmayer University, Osijek, Croatia
Interests: intensive medicine; anaesthesiology; analgosedation; analgesia; anesthesia

Special Issue Information

Dear Colleagues,

Postoperative care in neurosurgery is extremely complex and requires the care of various types of patients. This includes especially patients with neurotrauma, in whom, in addition to treating the central nervous system injury, accompanying injuries to other organs and systems must be treated, as well as the patient's comorbid conditions such as diabetes, hypertension or infections. Nutrition of patients with neurotrauma is particularly complex due to peristalsis disorders that often accompany central nervous system injuries. Early initiation of oral nutrition in awake patients, enteral nutrition in ventilator patients, or parenteral nutrition in situations where the gastrointestinal tract is dysfunctional should help maintain homeostasis in these patients. By preventing the occurrence of anemia, hypoproteinemia or electrolyte imbalances, early clinical nutrition is one of the measures that can help the patient in the sensitive period after an acute brain injury. The care of patients who undergo elective neurosurgical procedures is increasingly done according to the key principles of Enhanced Recovery After Surgery (ERAS). Postoperative pain control, early physical therapy, mobilization, and patient education are key elements of patient care after elective neurosurgical procedures. Implementation of ERAS protocols after elective neurosurgical procedures has shown improved outcomes but is still a challenge for emergency patients, especially those with impaired cognitive status. Determining the category of emergency patients who would benefit from the ERAS protocol may reduce the invasiveness of their treatment, the number of catheterization days, the number of central venous catheters, and thus the frequency of treatment complications. Along with postoperative pain management, infection prevention, and early neurorehabilitation, these aspects of treatment can improve postoperative recovery in neurosurgical patients. The goal of this Special Issue is to emphasize the importance of the previously mentioned aspects of postoperative treatment, and other interventions that can contribute to advances in the postoperative care of neurosurgical patients.

Dr. Slavica Kvolik
Guest Editor

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Keywords

  • postoperative care
  • neurosurgery
  • neurotrauma
  • enhanced recovery after surgery (ERAS)
  • postoperative pain
  • postoperative treatment

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Published Papers (1 paper)

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Review

19 pages, 1163 KB  
Review
Cerebral Vasospasm as a Critical Yet Overlooked Complication Following Tumor Craniotomy: A Systematic Review of Case Reports and Case Series
by Khairunnisai Tarimah, Dewi Yulianti Bisri, Radian Ahmad Halimi and Elvan Wiyarta
J. Clin. Med. 2025, 14(7), 2415; https://doi.org/10.3390/jcm14072415 - 1 Apr 2025
Cited by 1 | Viewed by 1598
Abstract
Background: Cerebral vasospasm after craniotomy tumor (CVACT) is a rare complication that can occur following tumor craniotomy and significantly affects the outcome of patients. Unfortunately, it is not well understood, leading to delayed and ineffective management. This study aims to investigate CVACT by [...] Read more.
Background: Cerebral vasospasm after craniotomy tumor (CVACT) is a rare complication that can occur following tumor craniotomy and significantly affects the outcome of patients. Unfortunately, it is not well understood, leading to delayed and ineffective management. This study aims to investigate CVACT by examining the factors contributing to its occurrence, its underlying mechanisms, diagnostic approaches, management strategies, and outcomes. The goal is to identify the characteristics and risk factors associated with CVACT, its clinical symptoms, diagnostic methods, management options, and potential outcomes. Methods: A systematic search used relevant keywords to identify cases of “cerebral vasospasm” after tumor resection in PubMed and Science Direct databases. Relevant cross-references were added by manually searching the references of all retrieved articles. Result: We included 60 inclusion patients from 14 case reports and 13 case series with 33 (55%) females and 27 (45%) males with a mean age of 44.05 ± 16.8 years. The most common tumors were pituitary adenomas, which were found in 22 (36.66%), the most common tumor location was the middle cranial fossa (75%), and the most common surgery technique used was transsphenoidal surgery (50%). Most of those who experience vasospasm have a craniotomy with the TSS technique (50%) with complications of intraoperative bleeding. The range of onset of VS symptoms postoperatively was 0–30 days (mean 6.59 d). The symptoms included asymptomatic, headache, loss of vision, hemiparesis, diplopia, etc. The vascular involvement was mainly anterior circulation (78.33%). The diagnostic tools most commonly used were angiography and transcranial doppler (TCD). The most common management of VS from the included studies was pharmacology. The survival rate was 61.66%. We found the tumor location and vascular-affected vasospasm were significantly correlated with mortality rates: p = 0.015 and p = 0.02. Conclusions: Cerebral vasospasm after craniotomy tumor removal (CVACT) frequently arises in tumors situated in the medial cranial fossa, predominantly pituitary adenomas and meningiomas. The minimally invasive surgical approach of TSS may contribute to the mechanism of CVACT incidence. The existence of preoperative vascular pathology, as encasement or narrowing, appears to be a predictor alongside the incidence of intra- or postoperative hemorrhage. The vascular structures most susceptible to vasospasm are located in the anterior circulation of the Willis circle, which appears to correlate with the vascular problems that typically undergo preoperative encasement of the internal carotid artery (ICA). The most reliable and real time diagnostic instrument employed is TCD, while imaging continues to be the gold standard. Nimodipine treatment continues to be a viable therapeutic option that can enhance patient outcomes. Full article
(This article belongs to the Special Issue Management of Postoperative Care in Neurosurgery)
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