ABSTRACT
The specialty of neuroanesthesia has greatly increased in terms of advancement over the past two decades, keeping pace with ever-growing technological developments in neurosurgery. The new surgical approaches and procedures bring new perioperative concerns—a few already known and others still emerging as incorporation of newer techniques in practice steadily increases. As life expectancy has increased, more and more geriatric patients present for operative procedures. The functional impact of surgery and associated comorbidities has a negative effect on the complication profile and may increase morbidity and mortality. These patients may have other coexisting systemic diseases which have important anesthetic concerns (Table 10.1). Minimally invasive surgical practice has flourished secondarily to the advancement in computer-assisted technology, imaging, optics, and surgical instruments. Neuroimaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) have been integrated with various advanced computerized software, which enable the surgeon to obtain a three-dimensional (3-D) view of an area of interest while operating. Stereotactic systems use co-registration of the patient with a preoperative imaging study and enable the surgeon to relate the location of instruments in the surgical field with preoperative imaging data. For the geriatric population, this translates into less invasive approach with minimal/no tissue retraction, resulting in less neural tissue damage, a more precise job, less pain, early recovery, and better outcomes. Fiberoptics have revolutionized visualization of the surgical area. Special endoscopes are inserted through a small incision, allowing visualization of even hidden areas, resulting in minimal dissection, less pain, minimal scarring, short surgical time, and earlier recovery. Lack of depth perception is a limitation that may be overcome by newer, more expensive 3-D endoscopy. Once the steep learning curve associated with use of endoscopes is surpassed, it is certainly advantageous overall. Robots in neurosurgical practice aid in carrying out minimally 150invasive surgeries. These integrate navigation and surgical planning with a robotic arm resulting in smaller incisions, more precision, and better access to the surgical area. Table 10.2 enumerates the various minimally invasive neurosurgical procedures.
