Neurosurgery

Neurocritical Care

At the Mount Sinai Health System, we take a collaborative approach to neurocritical care. We have three area hospitals with dedicated neurosurgical and neurological intensive care units (NSICU) staffed by board-certified neurointensivists (doctors who care for patients in the neurological and neurosurgical intensive care unit), as well as specialty-trained nurses, nurse practitioners, neurocritical care fellows, neurosurgery residents, social workers, rehabilitation therapists, pain care specialists, spiritual care specialists, and other support staff. Teams are available 24/7 to answer your questions and discuss the care of your loved one. In addition, our neurocritical care team collaborates closely with renowned experts in related areas including neurosurgery, neuro-endovascular care, stroke, and epilepsy.

In the NCCU, we treat a variety of types of patients, including:

  • Recovering from neurological surgeries and/or complex ear, nose, and throat procedures
  • Acute ischemic stroke
  • Subarachnoid hemorrhage
  • Intracerebral hemorrhage
  • Traumatic brain and spinal cord injuries
  • Brain tumors
  • Neuromuscular emergencies including myasthenia gravis, Guillain-Barré syndrome, meningitis, and encephalitis
  • Status Epilepticus including super-refractory status epilepticus and new-onset refractory status epilepticus
  • Anoxic brain injury
  • Coma

We develop plans for you, the patient, before and during as well as for recovery within the hospital and care after discharge. Your surgeon and care team will talk with you and your family about your individualized plan.

Coma Patient Monitoring

Our NSICUs use several monitoring devices to help us assess and observe the brain activity of patients in comas. Research shows that patients who receive specialized care at a neurointensive care unit following brain surgery or a neurologic emergency (such as stroke or traumatic brain injury) achieve better outcomes, increased quality of life, and shorter hospital stays.

If you or your loved one has experienced a neurological and neurosurgical illness, we monitor you very closely so that we can quickly detect and treat any potential problems. Patients in a coma may require non-invasive and invasive monitoring techniques so that we can carefully track what is happening and address it. 

We use a variety of devices to measure intracranial pressure, brain blood flow, brain oxygen, abnormal electrical activities, seizures, measure blood pressure, and cardiac output monitoring. We also use radiological imaging as needed, including computerized tomography (CT) scans, magnetic resonance imaging, and angiographic imaging. The most common tools in the NCCU are:

  • Therapeutic temperature management
  • Intracranial pressure monitoring
  • Brain tissue oximetry
  • Cerebral blood flow monitoring
  • Continuous electroencephalogram  monitoring
  • Pupillometry
  • Near infrared spectroscopy
  • Jugular venous oxygen saturation monitoring
  • Transcranial doppler
  • Invasive hemodynamic monitoring
  • Electroencephalogram
  • Magnetic resonance angiography
  • Invasive angiography
  • Point of care ultra-sonography

This intensive monitoring enables us tosee if there are in the brain, breathing, and blood flow. We use the Bedmaster System, which collects data at each bedside and helps us track trends, physiological relationships throughout the body, response to medications, ventilator settings, and the effectiveness of other interventions.

Patient Transfers

We accept neurosurgery and neurology patient from hospitals and health care facilities throughout the New York tri-state area. It is rare for a patient to be "too sick" to transfer in an ambulance to another hospital. The real risk may be in not transferring a patient soon enough. Ambulances are typically staffed by paramedics trained in advanced cardiac life support. There may be some risk while a patient is in transit, but we have to measure this against the potential benefits of beginning treatments as soon as possible.

Recovery and Rehabilitation

Once a patient has become medically stable and we complete all serious treatment, you start on your road toward recovery and rehabilitation. Our committed Mount Sinai neurocritical care, multi-disciplinary support teams, and therapists create individualized patient-specific treatments, activities, and goals to promote early activity, early mobilization, early removal of devices and catheters, and early weaning of ventilation.

Some neurologic disorders may cause temporary or permanent impairments. You may have problems with simple, daily functions or develop complex intellectual issues. Rehabilitation maximizes functional recovery and we begin as soon as we can after you become affected by the disorder or injury. Our goal is to help you to become as independent as possible.

We work with you and your family to plan your rehabilitation and discharge from the hospital. We understand that recovery and rehabilitation is a family affair and it greatly affects the lives of your primary caregiver and other family members and friends. For you, recovery often means learning new ways to perform old tasks. For your caregiver, it may involve adapting to and accepting you as you are now, including any permanent physical and/or cognitive limitations.

We use a variety of types of rehabilitation, including physical, occupational, speech, cognitive, psychological, and vocational treatment. These therapies maximize your physical strength and mobility, independence in performing activities of daily living (e.g. dressing, hygiene, and movement), ability to regain financial independence, reintegration into the community and social network, and psychological well-being.