[Anaesthesiological Concepts in Paediatric Neurosurgery]

Paediatric neurosurgery presents a unique set for the anaesthesiologist, necessitating a patient tailored approach for a diverse population, ranging from neonates to adolescents and from healthy to chronically ill children. Understanding the intracranial compartment as the sum of brain tissue, blood volume and cerebral spinal fluid is essential. Given that approximately a quarter of a child's cardiac output is dedicated to cerebral perfusion, intracranial bleeding might cumulate in haemorrhagic shock. Anaesthesiological measures to maintain homeostasis and their influences both on cerebral autoregulation and intracranial pressure need to be considered. Preoperative anaesthesiologic evaluation should incorporate neurological status and identification of underlying syndromes. Key perioperative considerations include airway management, strategic vascular access and haemotherapy. Anaesthetic requirements in common neurosurgical procedures for intracranial tumours, hydrocephalus, craniosynostosis as well as spinal surgery and traumatic brain injury are highlighted, while strategies to cope with complications such as seizure or air embolism are delineated.