Cerebral protection during neurosurgery and stroke

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Perioperative neuroprotection is crucial for patients undergoing brain surgery and those experiencing acute ischemic stroke (IAS).
• Numerous therapeutic approaches, both pharmacological and non-pharmacological, have been investigated with varied success.

Purpose of the Study:

• To review recent evidence on the efficacy of neuroprotective strategies in patients undergoing brain surgery.
• To evaluate neuroprotection in patients with acute ischemic stroke.

Main Methods:

• Systematic review of recent studies on perioperative neuroprotection.
• Analysis of pharmacological and non-pharmacological interventions for brain surgery and acute ischemic stroke.

Main Results:

• Intraoperative remifentanil or propofol showed no significant neuroprotective effects.
• Hypertonic saline may offer better brain relaxation than mannitol in intracranial tumor surgery.
• Magnesium sulfate did not improve neurological outcomes post-stroke.
• Endovascular treatment in acute ischemic stroke with specific characteristics improved outcomes.
• Conscious sedation may be safer than general anesthesia for endovascular clot evacuation.

Conclusions:

• Current evidence is insufficient to guide clinical management of neuroprotection.
• Further randomized clinical trials are essential to optimize patient care in neurosurgery and stroke management.