Abstract：
Nationwide databases show that iatrogenic stroke and postoperative hematoma are among the commonest complications in brain tumor surgery, with a 10-year incidence of 16.3/1000 and 10.3/1000, respectively. However, techniques for handling severe intraoperative hemorrhage and dissecting, preserving, or selectively obliterating vessels traversing the tumor are sparse in the literature.
Records of the senior author\'s intraoperative techniques during severe haemorrhage and vessel preservation were reviewed and analyzed. Intraoperative media demonstrations of key techniques were collected and edited. In parallel, a literature search investigating technique description in handling severe intraoperative hemorrhage and vessel preservation in tumor surgery was undertaken. Histologic, anesthetic, and pharmacologic prerequisites of significant hemorrhagic complications and hemostasis were analyzed.
The senior author\'s techniques for arterial and venous skeletonization, temporary clipping with cognitive or motor mapping, and ION monitoring were categorized. Vessels interfacing with tumor are labeled intraoperatively as supplying/draining the tumor, or traversing en passant, while supplying/draining functional neural tissue. Intraoperative techniques of differentiation were analyzed and illustrated. Literature search found 2 vascular-related complication domains in tumor surgery: perioperative management of excessively vascular intraparenchymal tumors and lack of intraoperative techniques and decision processes for dissecting and preserving vessels interfacing or traversing tumors.
Literature searches showed a dearth of complication-avoidance techniques in tumor-related iatrogenic stroke, despite its high prevalence. A detailed preoperative and intraoperative decision process was provided along with a series of case illustrations and intraoperative videos showing the techniques required to reduce intraoperative stroke and associated morbidity addressing a void in complication avoidance of tumor surgery.
Records of the senior author\'s intraoperative techniques during severe haemorrhage and vessel preservation were reviewed and analyzed. Intraoperative media demonstrations of key techniques were collected and edited. In parallel, a literature search investigating technique description in handling severe intraoperative hemorrhage and vessel preservation in tumor surgery was undertaken. Histologic, anesthetic, and pharmacologic prerequisites of significant hemorrhagic complications and hemostasis were analyzed.
The senior author\'s techniques for arterial and venous skeletonization, temporary clipping with cognitive or motor mapping, and ION monitoring were categorized. Vessels interfacing with tumor are labeled intraoperatively as supplying/draining the tumor, or traversing en passant, while supplying/draining functional neural tissue. Intraoperative techniques of differentiation were analyzed and illustrated. Literature search found 2 vascular-related complication domains in tumor surgery: perioperative management of excessively vascular intraparenchymal tumors and lack of intraoperative techniques and decision processes for dissecting and preserving vessels interfacing or traversing tumors.
Literature searches showed a dearth of complication-avoidance techniques in tumor-related iatrogenic stroke, despite its high prevalence. A detailed preoperative and intraoperative decision process was provided along with a series of case illustrations and intraoperative videos showing the techniques required to reduce intraoperative stroke and associated morbidity addressing a void in complication avoidance of tumor surgery.
摘要：
背景：全国数据库表明医源性卒中和术后血肿是脑肿瘤手术中最常见的并发症，10年发病率分别为16.3/1000和10.3/1000。然而,处理严重术中出血的技术，解剖，保存,在文献中，穿过肿瘤的选择性闭塞血管是稀疏的。
方法：文献检索调查处理严重，在肿瘤手术中进行术中出血和血管保存。组织学,分析了严重出血并发症和止血的麻醉和药理先决条件。并行,回顾并分析了高级作者在严重出血和血管保存期间的术中技术记录。收集并编辑了关键技术的术中媒体演示。
结果：文献检索显示肿瘤手术中两个血管相关并发症领域：过度血管的围手术期处理，实质内肿瘤，缺乏术中技术和解剖和保存的决策过程，连接或穿越肿瘤的血管。资深作者的动脉和静脉骨骼化技术，通过认知或运动映射进行临时剪切，和离子监测进行了分类。与肿瘤连接的血管在术中标记为供应/引流肿瘤，或者穿越过山车，同时供应/引流功能性神经组织。分析并说明了术中的分化技术。
结论：文献检索显示，在肿瘤相关医源性卒中中，缺乏避免并发症的技术，尽管患病率很高。提供了详细的术前和术中决策过程，以及一系列案例插图和术中视频，展示了减少术中中风和相关发病率所需的技术，解决了避免肿瘤手术并发症的空白。
方法：文献检索调查处理严重，在肿瘤手术中进行术中出血和血管保存。组织学,分析了严重出血并发症和止血的麻醉和药理先决条件。并行,回顾并分析了高级作者在严重出血和血管保存期间的术中技术记录。收集并编辑了关键技术的术中媒体演示。
结果：文献检索显示肿瘤手术中两个血管相关并发症领域：过度血管的围手术期处理，实质内肿瘤，缺乏术中技术和解剖和保存的决策过程，连接或穿越肿瘤的血管。资深作者的动脉和静脉骨骼化技术，通过认知或运动映射进行临时剪切，和离子监测进行了分类。与肿瘤连接的血管在术中标记为供应/引流肿瘤，或者穿越过山车，同时供应/引流功能性神经组织。分析并说明了术中的分化技术。
结论：文献检索显示，在肿瘤相关医源性卒中中，缺乏避免并发症的技术，尽管患病率很高。提供了详细的术前和术中决策过程，以及一系列案例插图和术中视频，展示了减少术中中风和相关发病率所需的技术，解决了避免肿瘤手术并发症的空白。
