Neurosurgery

A

• Acute Obstructive Hydrocephalus - Emergency

  Acute obstructive hydrocephalus is ventricular enlargement from blocked CSF flow and can cause rapid decline, vomiting, gaze abnormalities, bradycardia, coma, and herniation. Stabilize airway and perfusion, obtain emergent neuroimaging, avoid lumbar puncture when mass effect or obstruction is suspected, and obtain urgent neurosurgical CSF diversion with an EVD or other procedure while treating the obstructing lesion.
• Acute Subdural Hematoma - Trauma Management

  Acute traumatic subdural hematoma is blood between dura and arachnoid, usually from torn bridging veins or cortical vessels, and often reflects severe underlying brain injury. Prevent hypotension and hypoxemia, obtain immediate CT, reverse anticoagulation, and pursue urgent craniotomy or decompressive surgery for hematomas thicker than 10 mm, midline shift greater than 5 mm, or neurologic deterioration.
• Aneurysmal Subarachnoid Hemorrhage - Initial Management

  Secure airway when needed, control pain and blood pressure, give nimodipine, treat hydrocephalus, and arrange early aneurysm securing by coiling or clipping.

B

• Brain Abscess - Neurosurgical Drainage Indications

  Brain abscess requires urgent MRI or contrast CT, blood cultures, targeted antimicrobial therapy, and early neurosurgical and infectious-disease consultation. Stereotactic aspiration or excision is favored for many accessible lesions, especially when large, causing mass effect, diagnostically uncertain, or failing medical therapy.

C

• Cauda Equina Syndrome - Urgent Decompression

  Saddle anesthesia, bowel or bladder dysfunction, or severe bilateral sciatica require emergent MRI and surgical decompression to optimize neurologic recovery.
• Chronic Subdural Hematoma - Adult Management

  Chronic subdural hematoma is a slowly evolving blood and membrane collection, usually in older adults after minor trauma or in patients using antithrombotic therapy. Diagnose with CT, reverse or pause antithrombotics when clinically appropriate, evacuate symptomatic or enlarging collections with burr-hole drainage in most cases, and address recurrence risk with careful drain management, fall prevention, and selected middle meningeal artery embolization.

D

• Depressed Skull Fracture - Management

  A depressed skull fracture is a cranial fracture with inward displacement of bone and potential dural, vascular, sinus, or brain injury. Stabilize according to trauma principles, obtain thin-cut CT with bone windows, avoid probing open wounds, give tetanus and antibiotics for open contaminated fractures, and obtain urgent neurosurgical management for open depression, dural violation, significant displacement, contamination, CSF leak, hematoma, or neurologic deficit.

E

• Epidural Hematoma - Trauma Emergency Management

  Traumatic epidural hematoma is a neurosurgical emergency caused by bleeding between skull and dura, often after temporal bone fracture and middle meningeal arterial injury. Stabilize airway and circulation, obtain immediate noncontrast head CT, reverse anticoagulation, prevent hypotension and hypoxemia, and obtain urgent neurosurgical evacuation for large hematomas, neurologic deterioration, or herniation risk.
• External Ventricular Drain - Placement and Care

  An external ventricular drain provides both intracranial pressure monitoring and therapeutic CSF drainage in hydrocephalus, intraventricular hemorrhage, and selected severe brain injuries. Safe use depends on sterile insertion, correct transducer leveling, a clearly ordered drainage strategy, frequent neurologic and waveform assessment, prevention of overdrainage, and rapid response to obstruction or ventriculostomy-associated infection.

I

• Intracerebral Hemorrhage - Surgical Indications

  Surgery for spontaneous intracerebral hemorrhage is selective rather than routine. Immediate evacuation is strongly considered for cerebellar hemorrhage with neurologic deterioration, brainstem compression, obstructive hydrocephalus, or sufficiently large volume, while supratentorial craniotomy is individualized for deterioration or life-threatening mass effect and minimally invasive evacuation may benefit selected moderate-to-large hematomas.
• Intracranial Vasospasm After SAH - Management

  Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage is prevented and treated with early enteral nimodipine, euvolemia, frequent neurologic monitoring, and targeted evaluation for vasospasm or other causes of deterioration. Symptomatic DCI may benefit from blood-pressure augmentation, while refractory cases can require endovascular rescue.

M

• Malignant MCA Infarction - Decompressive Hemicraniectomy

  Malignant MCA infarction is a large hemispheric ischemic stroke complicated by life-threatening cerebral edema, usually worsening over the first several days. Neurocritical monitoring, treatment of reversible physiologic stressors, hyperosmolar rescue for deterioration, and early neurosurgical evaluation for decompressive hemicraniectomy are central to management.

N

• Neurogenic Shock After SCI - Vasopressors

  Neurogenic shock after acute spinal cord injury is distributive shock from loss of sympathetic tone, usually with cervical or high thoracic lesions. Exclude hemorrhage first, then restore adequate preload and spinal cord perfusion with vasopressors, often norepinephrine, while treating clinically significant bradycardia and associated respiratory failure.
• Normal Pressure Hydrocephalus - Evaluation and Shunt

  Idiopathic normal pressure hydrocephalus is a potentially treatable cause of gait impairment, cognitive decline, and urinary symptoms in older adults. Diagnosis integrates characteristic ventriculomegaly with the clinical pattern and exclusion of mimics; improvement after CSF removal supports shunt responsiveness but no single test perfectly predicts benefit.

P

• Penetrating Brain Injury - Initial Management

  Penetrating brain injury requires rapid trauma stabilization, preservation of the penetrating object until controlled surgery, CT and vascular imaging, early neurosurgical management, seizure and infection prevention when indicated, and meticulous avoidance of hypotension and hypoxemia. Injury trajectory, vascular involvement, CSF leak, contamination, and retained fragments determine operative strategy and prognosis.
• Pituitary Apoplexy - Acute Management

  Pituitary apoplexy is an endocrine and neurosurgical emergency caused by hemorrhage or infarction in a pituitary lesion. Suspect sudden severe headache with visual loss, ophthalmoplegia, altered consciousness, or acute adrenal insufficiency. Give stress-dose hydrocortisone when unstable or cortisol deficiency is suspected, obtain urgent MRI, and involve endocrinology and neurosurgery.
• Pituitary Apoplexy — Acute Headache, Visual Loss, Steroids, and Decompression

  Sudden severe headache with visual loss/ophthalmoplegia due to hemorrhage or infarction of a pituitary adenoma. Give stress‑dose steroids (e.g., hydrocortisone 100 mg IV bolus then 50 mg q6h), obtain urgent MRI and endocrine labs, correct electrolyte and volume derangements, and arrange neurosurgical decompression for visual compromise or neurologic deterioration.
• Posterior Fossa Mass - Acute Deterioration

  Acute deterioration from a posterior fossa mass can rapidly become fatal because the confined compartment permits little expansion before brainstem compression or obstructive hydrocephalus. Stabilize airway and perfusion, obtain urgent imaging, treat impending herniation with temporizing hyperosmolar measures, avoid unsafe lumbar puncture, and obtain immediate neurosurgical intervention.

S

• Spinal Epidural Abscess - Urgent Management

  Back pain with fever or neurologic deficits warrants MRI and early antibiotics; urgent decompression and debridement when neurologic impairment or instability.
• Spinal Epidural Abscess — Recognition & Management

  Spinal epidural abscess is infection in the epidural space that can compress the spinal cord or cauda equina and cause irreversible neurologic injury. The classic triad of back pain, fever, and neurologic deficit is insensitive, so diagnosis depends on maintaining suspicion in patients with severe focal spinal pain, bacteremia risk, elevated inflammatory markers, or evolving neurologic symptoms. Contrast-enhanced MRI of the entire clinically relevant spine is the diagnostic test of choice. New weakness, sph

T

• Traumatic Brain Injury - ICP Management

  Intracranial pressure management in severe TBI is a tiered strategy that begins with oxygenation, blood pressure, head positioning, sedation, temperature control, and CSF drainage when available, then escalates to hyperosmolar therapy, ventilation adjustments, deeper sedation, neuromuscular blockade, and selected decompressive surgery. Treat sustained ICP above the accepted threshold while preserving cerebral perfusion and avoiding secondary ischemia.
• Traumatic Spinal Cord Injury - Acute Management

  Acute traumatic spinal cord injury requires immediate spinal motion restriction, airway and perfusion support, rapid CT with MRI when indicated, serial neurologic examination, and early spine-surgery involvement. Prevent hypoxemia and hypotension, identify compressive instability, and consider decompression within 24 hours when feasible.