Anesthetic Management of Intracranial Aneurysms

Despite efforts in the past decades to improve outcomes, intracranial aneurysm surgery still carries a considerable mortality risk, and its complications can cause a marked disability. To optimize and safely anesthetize a patient for these high-risk surgeries, the anesthesiologist must have a detailed understanding of the natural history, systemic physiologic perturbations, and intraoperative and postoperative complications of intracranial aneurysms. Various grading scales are used to predict adverse events, such as vasospasm or mortality, and are outlined in this chapter. Endovascular coiling and open surgical clip ligation (clipping) are the two most commonly employed interventions for treatment of aneurysms. The anesthetic goals for these complex patients are summarized.   This review contains 2 tables and 59 references.  Key Words: adenosine, burst suppression, emergence hypertension, endovascular coiling, indocyanine green, intracranial aneurysm clipping, intraoperative hypothermia, motor evoked potentials