Managing neurosurgical complications in emergency settings: An evidence-based review of challenges and strategies

Abstract

Neurosurgical complications in emergency settings present significant challenges, requiring prompt and expert intervention. This evidence-based review analyzes critical post-operative complications, including infections (post-craniotomy, post-spinal, and rare pathogens), hematomas (epidural, subdural, intracerebral), seizures, cerebrospinal fluid (CSF) leakage, ischemia, elevated intracranial pressure (ICP), and hydrocephalus. Special emphasis is placed on ventriculoperitoneal (VP) shunt malfunctions and aneurysmal subarachnoid hemorrhage (aSAH) rebleeding, highlighting their pathophysiology, diagnostics, and management.

The review explores risk factors, clinical presentations, and advanced diagnostics like quantitative near-infrared spectroscopy (Q-NIRS) for ischemia. Treatment protocols include surgical interventions (e.g., craniotomy, endoscopic third ventriculostomy), medical management (e.g., antiepileptic drugs, hyperosmolar therapy), and preventive measures.

From a triage perspective, the review underscores the neurosurgeon's critical role in prioritizing time-sensitive emergencies, such as favoring immediate evacuation for a life-threatening epidural hematoma over other urgent cases, a decision that profoundly impacts survival.

Ethical and logistical challenges in emergency neurosurgery are examined, particularly in resource-limited settings, addressing triage dilemmas, consent issues, and global disparities in care access. The review synthesizes recent advancements, such as telemedicine and novel therapies like tranexamic acid for aSAH, while underscoring multidisciplinary collaboration.

By integrating current research and clinical best practices, this review aims to equip neurosurgeons and healthcare providers with actionable insights to optimize patient outcomes in high-stakes emergencies.