The division of neurosurgical anesthesiology is an extremely active service performing over 2200 anesthetics annually. There are currently six full time anesthesiology attendings associated with this division, headed by Dr. Alex Bekker. Members of this group provide anesthesia in the operating room, neuroradiology suite, and, occasionally, in MRI and CT scan suites. The neurophysiology monitoring group directed by Dr Mark Bloom is responsible for SSEP, MEP, and EEG monitoring. Most of our neurosurgeons prefer to conduct neurological exam at the end of the procedure. To meet this challenge, we monitor level of consciousness using a BIS monitor on most of our patients. Unless there is unanticipated intraoperative complication requiring prolonged intubation, all of our patients are awake and alert on emergence.

Clinical Case Mix

Patients requiring surgery have almost every type of neurosurgical procedure available. Craniotomies are performed for patients with intracerebral tumors, vascular lesions, and functional neurological problems such as epilepsy and movement disorders involving basal ganglia disease. NYU Langone Medical Center is an internationally recognized center for computer-assisted stereotactic surgery. These patients often arrive with head frames and require special devices for airway management.

About 30 % of patients undergoing craniotomies under general anesthesia are monitored for SSEP and MEP. For these procedures, we use intravenous anesthetics and analgesics only.

The epilepsy center at the NYU Langone Medical Center refers many patients for surgery. Because of this, we provide anesthesia for many patients with epilepsy. While many cases are performed under general anesthesia, some are performed as "awake craniotomies" particularly when cerebral areas associated with language have to be examined intraoperatively.

The NYU Langone Medical Center has a long tradition as a center for management of patients with vascular lesions. We provide anesthesia for patients with arteriovenous malformations, cerebral aneurysms, and, occasionally, carotid artery stenosis.

Spine surgery represents another area of strength. Besides the routine spinal discectomies, we also provide anesthesia for patients having more complicated spinal procedures requiring spinal stabilization. About 50% of these procedures involve intraoperative electrophysiologic monitoring. Patients with cervical spine disease are intubated using special devices for airway management (fiberoptic scope, intubating LMA, etc.).

Our invasive neuroradiology department is very active. Our neuroradiologists perform neuroradiographic procedures primarily for intracerebral or spinal vascular lesions. These include arteriovenous malformations and aneurysms. In addition, vascular lesions involving the periphery are treated. Most of these patients require general anesthesia.

In summary, the division of neurosurgical anesthesiology provides a broad experience in traditional as well as in special neurosurgical cases.