The division of neurosurgical anesthesiology is an extremely active division performing over 2100 anesthetics annually. Patients requiring neurological surgery have almost every type of procedure. The large number of cases and types of procedures provides a superb teaching opportunity.
About half of the surgeries are craniotomies for patients with intra-cerebral tumors, vascular lesions and control of epilepsy. The remaining surgeries are for peripheral vascular and peripheral nerve diseases, functional neurosurgery for treatment of movement disorders and epilepsy, spine surgery for treatment of radiculopathies, myelopathies, spondyloses and tumors.
Many patients come to the Columbia University Medical Center for treatment with functional neurosurgery. The Epilepsy Center at CUMC evaluates patients with epilepsy for treatment with surgery. Most craniotomies for epilepsy are performed under general anesthesia, however, some are performed as "awake craniotomies" particularly when cerebral areas associated with language have to be examined intra-operatively. Patients with movement disorders have placement of deep brain stimulators performed with MRI and/or electrophysiological guidance.
The division of vascular neurosurgery is a center of excellence in the management of patients with vascular lesions. Patients with arteriovenous malformations, cerebral aneurysms, and carotid artery stenosis may be treated with either endovascular and surgical modalities. The members of the division of Neurosurgical Anesthesiology provide anesthesia for both.
The neuroradiologists perform neuroradiographic procedures primarily for intra-cerebral or spinal vascular lesions. These include arteriovenous malformations, aneurysms, and carotid artery stenosis. In addition, vascular lesions involving the periphery are treated.
Patients requiring electroconvulsive therapy are treated both at The New York State Psychiatric Institute and at the Milstein Hospital Pavilion. The Division of Biological Psychiatry for many years has provided these services. Members of this division are involved in a number of clinical and laboratory research projects to determine the mechanisms of efficacy of this type of therapy.
Our spine surgery center has had increasing volume of patients who require ever more complicated spinal procedures requiring intra-operative electrophysiological monitoring. A considerable amount of time is spent teaching how to interpret results of electrophysiological monitoring.
There are currently nine anesthesiology attendings associated with the division of Neurosurgical Anesthesiology, headed by Dr. Eric J. Heyer. Members of this division provide anesthesia in the operating room, neuroradiology suite, and off-site in the Department of Psychiatry for patients having electroconvulsive therapy. Teaching occurs both in the operating room as well as in small didactic sessions held every morning.
In summary, the division of neurosurgical anesthesiology provides a broad experience in traditional as well as in special neurosurgical cases.