Faculty Advisor(s)

John Hanlon

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© 2017 Morgan Cornell


In neurosurgical procedures, including craniotomy for tumor, neurosurgeons often require a reduction of brain swelling to optimally perform the surgery. The reduction of brain swelling is termed brain relaxation. The anesthesia professional can accomplish brain relaxation using multiple techniques. One such technique is the infusion of certain intravenous fluids to change the osmotic pressure within the cranial vault thereby reducing brain edema (Jaffe, 2014). Highly osmolar fluids such as mannitol and hypertonic saline can be infused to decrease brain edema. Currently, mannitol remains the gold standard for medical treatment of intracranial pressure in neurosurgical procedures (Marko, 2012). This review seeks to know how hypertonic saline compares to mannitol to decrease brain edema and improve surgical field conditions in adult craniotomy patients for tumor resection. Cochrane Collections Plus and MEDLINE were searched for studies comparing the use of hypertonic saline versus mannitol for brain relaxation. Both mannitol and hypertonic saline decrease brain edema in the adult craniotomy patient. This literature review suggests that hypertonic saline significantly improves brain relaxation for surgeons during craniotomy for tumor resection, while maintaining stable hemodynamics.


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