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    Brain Aneurysm

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    Hu Eyong
    Brain aneurysms occur when there is a localized dilation or ballooning of a blood vessel in the brain. They affect 1-2% of the population and are most common in the circle of vessels around the base of the brain. The two main types are saccular, which accounts for 80-90% of cases, and fusiform. Prior to surgery, equipment like microscopes and aneurysm clips must be prepared, as well as ensuring CT scans are available to reference during the procedure. Post-operatively, patients are closely monitored for neurological changes and complications, with the goal of maintaining adequate perfusion and drainage from the brain. Education is provided on discharge regarding follow-up care.

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    Brain Aneurysm

    Uploaded by

    Hu Eyong
    544 views26 pages
    Brain aneurysms occur when there is a localized dilation or ballooning of a blood vessel in the brain. They affect 1-2% of the population and are most common in the circle of vessels around the base of the brain. The two main types are saccular, which accounts for 80-90% of cases, and fusiform. Prior to surgery, equipment like microscopes and aneurysm clips must be prepared, as well as ensuring CT scans are available to reference during the procedure. Post-operatively, patients are closely monitored for neurological changes and complications, with the goal of maintaining adequate perfusion and drainage from the brain. Education is provided on discharge regarding follow-up care.

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    Brain aneurysms occur when there is a localized dilation or ballooning of a blood vessel in the brain. They affect 1-2% of the population and are most common in the circle of vessels around the base of the brain. The two main types are saccular, which accounts for 80-90% of cases, and fusiform. Prior to surgery, equipment like microscopes and aneurysm clips must be prepared, as well as ensuring CT scans are available to reference during the procedure. Post-operatively, patients are closely monitored for neurological changes and complications, with the goal of maintaining adequate perfusion and drainage from the brain. Education is provided on discharge regarding follow-up care.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    544 views26 pages

    Brain Aneurysm

    Uploaded by

    Hu Eyong
    Brain aneurysms occur when there is a localized dilation or ballooning of a blood vessel in the brain. They affect 1-2% of the population and are most common in the circle of vessels around the base of the brain. The two main types are saccular, which accounts for 80-90% of cases, and fusiform. Prior to surgery, equipment like microscopes and aneurysm clips must be prepared, as well as ensuring CT scans are available to reference during the procedure. Post-operatively, patients are closely monitored for neurological changes and complications, with the goal of maintaining adequate perfusion and drainage from the brain. Education is provided on discharge regarding follow-up care.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 26

    Brain Aneurysm

    Fan xiu lan Lu qiao xian

    Cerebral or Brain Aneurysm

    A cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel.

    Brain Aneurysm
    1-2% of the population have unruptured aneurysms Any aneurysm can rupture, although statistically larger (>1cm 4%) aneurysms are more likely to do so. Women>Men, incidence increases linearly with age 10-15% of patients presenting with SAH have multiple aneurysms

    Anatomy of Brain

    Located inside the skull, the brain has many specialized groups of cells. The 4 ventricles inside the brain make cerebrospinal fluid (CSF). The brain receives blood from 2 main groups of arteries(Int. & Ext. carotid arteries) It is connected to the spinal cord. The brain and spinal cord are called the bodys central nervous system.

    30-35%

    30-35% 20%

    5%

    Types of Brain Aneurysm


    Saccular Aneurysm
    The most common type of aneurysm and account for 80% to 90% of all intracranial aneurysms The most common cause of nontraumatic subarachnoid hemorrhage (SAH) Circle of vessels around the base of the brain where most aneurysms are found

    Types of Brain Aneurysm


    Fusiform Aneurysm

    An irregular shaped widening of a cerebral vessel that does not have a discrete neck or pouch of the side of a vessel. less common type of aneurysm. It looks like an outpouching of an arterial wall on both sides of the artery or like a blood vessel that is expanded in all directions. The fusiform aneurysm does not have a stem and it seldom ruptures.

    Types Of Brain Aneurysm

    Pre-operative Considerations

    Two diathermy machine Two suction machine Positioning devices are ready Microscope and Micro instruments Bipolar bayonet Legend and tools Theatre set up To standby blood product CT angiography images Haemostatic agent: Floseal and surgicel

    Positioning Devices

    Mayfield Clamp Device


    attachments

    Positioning Devices
    Sugita Head Frame

    Pre-operative Preparation

    Aneurysm clips and appliers (minimum 2) of the surgeons choice must be available

    Pre-operative Preparation

    The environment should be as quiet as possible, with minimal physiological and psychological stress. Elevate the head of the trolley 30 to 45 degrees Limit visitors to immediate family and significant others. Discourage and control any measure that initiates Valsalvas maneuver, such as coughing, straining at stool, pushing up in bed with the elbows, turning with the mouth closed. Educate patient about these. Maintain seizure precautions ( have suction equipment and oropharyngeal tube at the

    Intra-operative Considerations

    Microscope & TV system

    Drape the microscope after the head preparation has been completed

    Preparing the Microscope

    Light intensity Drape

    Intra-operative Considerations
    To standby blood product CT angiography images are available to refer intra-operatively Management of BP by anesthetist

    Post-operative Considerations

    Immediate Post-operative Care


    Monitoring of neurologic exam and vital signs Frequent assessment of airway patency and oxygenation continue IV fluids are maintained to assure adequate hydration Maintaining the systolic pressure at less than 200 mm Hg has been recommended (Suarez, Tarr, & Selman, 2006).

    The goal of BP management is to maintain perfusion of brain tissue and prevent ischemia

    Continued ICP monitoring.


    Prolonged elevations in ICP are associated with decreased cerebral perfusion pressure and increase the risk of cerebral

    Post-operative Considerations

    promote venous drainage by elevating the head of the bed 20 to 30 degrees. Emotional support of the patient and family is also important. The patient may be dealing with a neurological deficit, such as paralysis on one side of the body or loss of speech. If the patient cannot speak, establish a simple means of communication such as using a slate to write messages or using cards. Encourage the patient to verbalize fears of dependency and of becoming a burden.

    Discharge and Home Health Care Guidelines


    Prepare the patient and family for the possible need for rehabilitation after the acute care phase of hospitalization. Instruct the patient to report any deterioration in neurological status to the physician. Stress the importance of follow-up visits with the physicians. Be sure the patient understands all medications, including dosage, route, action and adverse effects, and the need for routine lab monitoring if anticonvulsants

    References
    Jane C. R. (2007). Alexanders care of the patient in surgery (13th ed.). St. Louis, Mosby Elsever. Priscilla L. & Karen B.(2004). Medical surgical nursing- critical thinking in client care (3rd ed.). New Jersey, Pearson Education.

    To Find Out More at


    http://www.mayoclinic.com/health/brai n-aneurysm/DS00582 http://www.emedicinehealth.com/aneu rysm_brain/article_em.htm

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