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)

• Fellows’ and Residents’ Audio Corner
  • Anesthesia for epilepsy surgery (December 2019, Dr. Susana Vacas)
• PBLD
  • Anesthesia for epilepsy surgery

 Posterior fossa surgery

• Quiz
  • Trigeminal Neuralgia
• 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 complications

• Quizzes
  • Monitoring
  • General Neuroanesthesia
  • 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)
• PBLD
  • Sitting craniotomy
• Fellows’ and Residents Audio Corner
  • 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)
  • Anesthetic management during transsphenoidal pituitary surgery, Current Opinion in Anaesthesiology

 Difficult airway  

• Quiz
  • 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)