A SIAARTI Neuroanesthesia and Neurointensive Care Section survey on elective neurosurgery and interventional neuroradiology

Background The data available at the national level in Italy regarding elective neurosurgical and neuroradiological procedures are limited. This survey aimed to explore clinical practices across Italian centers, focusing on anesthetic strategies, monitoring, and postoperative management. Methods A nationwide survey was conducted, collecting data from centers performing elective craniotomies and interventional neuroradiology. Questions addressed procedural volumes, anesthesia type, monitoring tools, and intraoperative and postoperative management. Results Among 49 responding centers, 21 were high-volume (>150 craniotomies/year). Intravenous anesthesia was the preferred anesthesia method, though not uniformly applied across volume groups. Awake craniotomy was rarely performed, even in high-volume centers. Bispectral Index (TM) monitoring was reported in 71.7% of centers, but without correlation to center volume. Anti-epileptic prophylaxis was routinely used in 73.9% of high-volume centers. Practices regarding intraoperative awakening and postoperative computer tomography scans varied widely: 53.5% performed them routinely in the postoperative period. In addition, 42.5% of physicians still adopted delayed awakening for neuroprotection purposes. Intensive care unit admission was not universally applied, reflecting a growing trend toward selective monitoring and enhanced recovery protocols. Discussion Large-volume centers do not always align with the best evidence available, albeit the limitation in the literature. In many centers, there is still indiscriminate use of anti-epileptic prophylaxis, admission to the critical care unit after craniotomy, and computed tomography in conscious patients in the immediate postoperative period: habits and preferences, however, for which there are no clear and consistent answers in the literature. Conclusions This survey reveals significant heterogeneity in the anesthetic and perioperative practices across Italian centers, independent of surgical volume. The absence of a dedicated national database limits broader analysis. Establishing such a registry could guide protocol standardization, training, and resource optimization in elective neurosurgical and neuroradiological care.