In week four, the trainee will review the following procedures with more emphasis on independent decisions about technique, monitoring, and approach to complications.

• Epilepsy surgery
• Vagal nerve stimulator placements
• Posterior fossa surgeries, microvascular decompression of cranial nerves, trigeminal neuralgia surgery, and Arnold-Chiari malformation surgery
• Complex neurosurgical positioning
• Transsphenoidal pituitary resection

 Epilepsy Surgery

• Quizzes:
  • Seizure Surgery
  • Anesthetic Management of Patients for and With Vagal Nerve Stimulators
• Articles:
  • Review: Anesthesia for Epilepsy Surgery. (PMID: 33456862)
  • The Anesthetic Considerations of Intraoperative Electrocorticography During Epilepsy Surgery. (PMID: 23780418)
  • Anesthetic Considerations for Stereotactic Electroencephalography Implantation (PMID: 31920225)
  • Vagal Nerve Stimulation: Overview and Implications for Anesthesiologists. (PMID: 17056962)

• Podcast:
  • Anesthesia for Epilepsy Surgery (December 2019, Dr. Susana Vacas)
• PBLD:
  • Anesthesia for Epilepsy Surgery

 Posterior Fossa Surgery

• Quiz:
  • Trigeminal Neuralgia
  • Craniovertebral Junction Anomalies
• Articles:
  • Anesthetic Management of Patients Undergoing Open Suboccipital Surgery. 2021 (PMID: 33563388)
  • Intraoperative Hypertensive Urgency and Hemodynamic Instability During Microvascular Decompression for Trigeminal Neuralgia.

 Complex Neurosurgical Positioning and Associated Complications

• Quizzes:
  • Clinical Monitoring
  • Considerations with positioning for neurosurgical procedures
  • Patient Positioning During Surgery
• Articles:
  • Risks and Benefits of Patient Positioning During Neurosurgical Care. (PMID: 17884711)
  • Feasibility of Intraoperative MRI Guidance for Craniotomy (PMID: 21593689)
  • A Standardized Protocol for the Prevention of Clinically Relevant Venous Air Embolism During Neurosurgical Interventions in the Semisitting Position (PMID: 19240616)
  • Cognitive Aids for the Diagnosis and Treatment of Neuroanesthetic Emergencies: Consensus Guidelines on Behalf of SNACC 2019. (PMID: 30334936)
  • Analysis of Risk Factors for Venous Air Embolism in the Semi-Sitting Position and its Impact on Outcome in a Consecutive Series of 740 Patients (PMID: 34740183)
• PBLD:
  • Sitting Craniotomy
• Podcast:
  • Anesthesia for Sitting Craniotomy- (January 2016, Dr. Jeffrey Pasternak)
  • Positioning for Neurosurgical Procedures (March 2022, Dr. Val Luoma)

Transsphenoidal Pituitary Resection

• PBLD:
  • Patient with Pituitary Adenoma for Transsphenoidal Resection
• Quiz:
  • Pituitary Surgery
  • Transsphenoidal Surgery for Pituitary Tumor
  • Complications of Pituitary surgery
• Articles:
  • Anesthesia and Intensive Care Implications for Pituitary Surgery: Recent trends and Advancements(PMID: 22029028)
  • Perioperative Management of Patients Undergoing Transsphenoidal Pituitary Surgery (PMID: 16192540)

 Difficult Airway  

• Quizzes:
  • Article of the Month: Airway Management with Stereotactic Frame in place
  • Airway Management in the Neurosurgical Patients
• SNACC Article of the Month Commentary:
  • Emergency Airway Management During Awake Craniotomy: Comparison of 5 Techniques in a Cadaveric Model

Supplementary Reading (SNACC Bibliography Collection)

• Anesthesia and Epilepsy (Neurosurgery → Anesthesia and Epilepsy, Neurointensive care → Status Epilepticus)
• Beach Chair Position (Neurosurgery → Beach Chair Position)