Does communication between neurosurgeons and anesthesiologists improve preoperative efficiency?

BACKGROUND: Suboptimal communication can lead to preventable preoperative delays. In our study, we aimed to identify factors delaying surgery in the immediate preoperative period. Our outcomes of interest were the anesthesia release to incision time (RIT) and preoperative expectations of neurosurgery and anesthesia providers. Additionally, we introduced new communication goals prior to induction, to examine the impact on preoperative efficiency. METHODS: The study is a prospective cohort analysis evaluating communication in the immediate preoperative period. In 42 consecutive cranial neurosurgical cases, a questionnaire was given to neurosurgical and anesthesia providers, and their responses were recorded. Halfway through this study, a formal pre-induction checklist was implemented that included expected duration of surgery, expected blood loss, surgical positioning, and intraoperative medication requirements. RESULTS: Comparing the cohorts before and after implementing the checklist, no difference in release to incision time was observed. However, the difference in estimated procedure time was significantly decreased after implementation of the formal pre-induction checklist. Further, there was a trend towards better agreement in estimated blood loss, although results did not achieve statistical significance. These delays all demonstrated a statistically significant decrease after the new communication goals were executed. CONCLUSION: While no statistically significant change in release to incision time was uncovered during our study, there was evidence that communication between teams improved after implementation of the checklist. Additionally, we observed less discrepancy in estimated case length and blood loss, suggesting focused communication goals aligned expectations of the neurosurgical and anesthesia teams.

Neonatal bilateral cerebral high flow fistulae leading to detection of a HHT-family carrier.

Cerebral and spinal cord high-flow arteriovenous fistulae (HFAVF) are part of the spectrum of lesions found in Hereditary Hemorrhagic Telangiectasia (HHT). HFAVF consist of communications between large arteries and veins without interposed nidi or capillary transitions. The association between HHT and cerebral or spinal HFAVF in children has been reported and suggested as a potential marker for HHT. We present a newborn with bilateral intracranial HFAVF tested positive for HHT1 and belonging to a family non known for carrying a HHT mutation. We also review reported cases of neonates and infants with cerebral and spinal HFAVF emphasizing their associations with genetic syndromes. Our aim is to add a new case to the pertinent literature and emphasize the need for molecular testing in children with spinal or brain HFAVF.

The natural history and treatment options for unruptured intracranial aneurysms.

Recent advances in angiographic technique have raised our awareness of the presence of unruptured intracranial aneurysms (UIAs). However, the appropriate management for these lesions remains controversial. To optimize patient outcomes, the physician must weigh aneurysmal rupture risk associated with observation against the complication risks associated with intervention. In the case that treatment is chosen, the two available options are surgical clipping and endovascular coiling. Our paper summarizes the current body of literature in regards to the natural history of UIAs, the evolution of the lesion if it progresses uninterrupted, as well as the safety and efficacy of both treatment options. The risks and benefits of treatment and conservative management need to be evaluated on an individual basis and are greatly effected by both patient-specific and aneurysm-specific factors, which are presented in this paper. Ultimately, this body of data has led to multiple sets of treatment guidelines, which we have summated and presented in this paper.