[Comprehensive Perioperative Management in Craniotomy: Practical Strategies to Optimize Surgical Outcomes]

Craniotomy is a fundamental procedure in neurosurgical practice, and optimal perioperative management is essential for improving surgical outcomes and minimizing complications. Comprehensive care requires meticulous attention to intracranial pressure control, cerebral edema management, fluid and electrolyte homeostasis, hemodynamic stability, infection prophylaxis, and nutritional support. Adequate preoperative evaluation and correction of systemic conditions, optimization of antithrombotic therapy, and appropriate use of osmotic agents and corticosteroids are critical for ensuring safe surgical intervention. Prompt neurological assessment, timely neuroimaging, and close monitoring of intracranial dynamics are essential for the early detection of postoperative complications. Electrolyte disturbances, particularly hyponatremia, caused by the inappropriate antidiuretic hormone secretion or cerebral salt-wasting syndrome, remain common and require accurate differentiation and tailored management. Glycemic control, blood pressure regulation, prevention of postoperative seizures, and antimicrobial prophylaxis play pivotal roles in reducing postoperative morbidity. In elderly patients, preoperative assessment of sarcopenia and nutritional status is increasingly recognized as a key determinant of functional recovery. This review provides a practical, evidence-based framework for the perioperative management of craniotomy, integrating current guidelines and clinical experience, and aims to serve as a comprehensive reference for neurosurgeons in routine clinical practice.