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Neurosurgical Intensive Care

Zinn, Pascal O. MD, PhD; Luedi, Markus M. MD, MBA

doi: 10.1213/ANE.0000000000002448
Books, Multimedia, and Meeting Reviews

Published ahead of print August 29, 2017.

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, Departments of Neurosurgery, Cancer Systems Imaging, and Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas

Department of Anesthesiology, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland,

Published ahead of print August 29, 2017.

Neurosurgical intensive care is multidisciplinary and is aimed at reducing morbidity and mortality in adult and pediatric patients after neurosurgery. These patients often suffer from deleterious conditions such as tumor, stroke, hemorrhage, infection, and associated neurological conditions and complications. As neurosurgeons, neurologists, intensive care specialists, resident program directors, and department chairs, the editor and authors of the second edition of Neurosurgical Intensive Care understand these challenges. They have thoughtfully organized the chapters from the initial “bedside neurologic exam” to the final “discharge planning for the neurosurgical intensive care patient.”

This edition of Neurosurgical Intensive Care is available either in softcover or as an ebook. The authors survey the spectrum of neurosurgical intensive care including medical dimensions, such as intracranial pressure and seizure therapy and fluid and ventilator management, and human dimensions, such as brain death and family communication. Each chapter begins with a brief abstract and an introductory case presentation, and ends with a discussion of state-of-the-art management of the introductory case. Well-structured subheadings provide a good framework for the presentation of current evidence. Each chapter includes well-organized tables and a comprehensive list of available evidence.

Of some concern, it appears that the editor and the authors may have overlooked diseases such as aneurysmal subarachnoid hemorrhage, intracranial hemorrhage, and (complex) stroke, all fundamental issues in neurosurgical intensive care. Additionally, respective chapters on periprocedural care considering issues such as the assessment and management of vasospasm during interventional neuroradiological procedures for thrombectomy, the role of craniectomy, the care of postcraniectomy patients, and stepwise incremental ICP management are missing. Because these approaches and procedures significantly contribute to the management and overall outcome of the patient today and due to the notable differences in the specific management of diagnoses such as aneurysmal subarachnoid hemorrhage, intracranial hemorrhage, and (complex) stroke, a future edition would benefit tremendously from addition of these topics. Moreover, other than the traditional citation of literature and 31 illustrations, Neurosurgical Intensive Care provides no links to web resources or audiovisual data.

While adequate, the electronic version does not add extra resources and would stand to benefit from links to enhanced audiovisual materials. Given the extensive global burden of neurosurgical intensive care cases and the increasingly complex array of therapeutic options, any and all measures should be available for reducing morbidity and mortality. In this regard, both anesthesiologists and neurosurgeons would be well advised to become more knowledgeable about the point of view of “the other” and to extensively, reliably, and readily collaborate interprofessionally. In-depth understanding of the treatment approach will increase both the value of care (quality/cost) and patient satisfaction and simultaneously decrease the fragmentation of surgical care, the 3 components of the perioperative surgical home introduced by Vetter et al.1

We think that in 2017, a text on neurosurgical intensive care might include dimensions beyond questions covered by national and international guidelines. We hope the editor will also embrace modern evidence in future editions such as, for example, the fact that near-infrared spectroscopy can be used to monitor a patient’s neurological status beyond the Glasgow Coma Scale and hemodynamics,2 or the fact that corticosteroids not only reduce cerebral edema but may also induce protumorigenic effects in glioblastoma.3

We recommend that both neurosurgeons and anesthesiologists caring for patients in neurosurgical intensive care read this book and use it as a reference. Javed Siddiqi has provided a good introductory source for neurointensivists, written by experts on their individual topics, on evidence-based approaches to neurosurgical intensive care.

Pascal O. Zinn, MD, PhDDepartment of NeurosurgeryBaylor College of MedicineHouston, TexasDepartments of Neurosurgery, Cancer Systems Imaging, and Cancer BiologyThe University of Texas MD Anderson Cancer CenterHouston, Texas

Markus M. Luedi, MD, MBADepartment of AnesthesiologyBern University Hospital InselspitalUniversity of BernBern,

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1. Vetter TR, Boudreaux AM, Jones KA, Hunter JM Jr, Pittet JF. The perioperative surgical home: how anesthesiology can collaboratively achieve and leverage the triple aim in health care. Anesth Analg. 2014;118:1131–1136.
2. Mashour GA, Woodrum DT, Avidan MS. Neurological complications of surgery and anaesthesia. Br J Anaesth. 2015; 114:194–203.
3. Luedi MM, Singh SK, Mosley JC, et al. A dexamethasone-regulated gene signature is prognostic for poor survival in glioblastoma patients. J Neurosurg Anesthesiol. 2017;29:46–58.
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