The Neuroanesthesia Section performs more than 1,600 anesthetics for neurosurgical and interventional neuroradiologic procedures each year. As a major referral center for children and adults with nervous system disorders, we provide anesthesia for a wide variety of neurosurgical interventions in patients with simple and complex neuropathology. Our patient population ranges from the smallest neonate through the geriatric years.
We actively collaborate with the Department of Neurosciences, Neurosurgical Critical Care and Interventional Neuroradiology to improve patient care, efficiency, safety and research. The Department of Neurosciences is the only neuroscience department in the country to combine basic neuroscience/physiology research with the clinical expertise of our neurologists and neurosurgeons. This uniquely positions the Division of Neurosurgery and the Neuroanesthesia Section on the cutting edge of neuroscience research, facilitating the application of research discovery to patient care.
Thirty-five percent of our neurosurgical procedures are craniotomies performed for intracerebral tumors, vascular lesions, traumatic brain injury, movement disorders and neurovascular compression syndromes. We have a very active skull base surgery program for patients with meningiomas, chordomas, acoustic neuromas, head and neck cancers, and orbital tumors. Although the majority of craniotomies are performed under general anesthesia, we also perform “awake craniotomies” when speech or movement must be examined intraoperatively.
Approximately 30 percent of our cases are routine or complicated spinal surgery. The more complicated surgical procedures often introduce the need for advanced anesthetic management techniques. Selected cases involve neurophysiologic monitoring for early detection of intraoperative electrophysiologic disturbances along neural pathways. One lung ventilation technique may be performed for anterior thoracic spine procedures performed through a thoracotomy incision. Many of our patients with significant disease or trauma of the cervical spine require advanced airway management skills or special devices to enhance patient safety.
As part of MUSC’s Children’s Hospital, we have the opportunity to provide anesthesia for neonates, infants and children undergoing neurosurgical procedures, ranging from ventriculoperitoneal shunts, to intracranial procedures, cerebrovascular operations and complex craniofacial surgery. Pediatric patients constitute about 20 percent of our neurosurgical patient population.
The Medical University of South Carolina has developed very strong programs and clinics for patients with movement disorders, intractable pain syndromes, and epilepsy. Consequently, we perform a large number of anesthetics for functional and stereotactic neurosurgical procedures for movement disorders, ablative and implantable device surgical therapies for intractable pain, and vagal nerve stimulation, cortical resection, or hemispherectomy for intractable seizures. We were the first program to report the use of an implantable vagal nerve stimulator for major depression.
Our Interventional Neuroradiology Department is one of the most active in the Southeastern United States. We administer anesthesia for approximately four cases each week in the neuroangiography suite. The majority of these procedures are for patients with intracerebral aneurysms and arteriovenous malformations who require general anesthesia.
Dorothea Rosenberger Parravano, MD, PhD