Journal of Angiotherapy
Angiogenesis, Inflammation & Therapeutics | Online ISSN  2207-872X
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RESEARCH ARTICLE   (Open Access)
Contents Vol 8 (6)

Anesthetic Management in Pediatric Craniotomy with Intraoperative Neurophysiological Monitoring: A Case Report of Midcerebellar Medulloblastoma

Irwan Setiadi 1, Muhammad Rezanda Alifahna 1*, Radian Ahmad Halimi 1, Dewi Yulianti Bisri 1

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Journal of Angiotherapy 8 (6) 1-5 https://doi.org/10.25163/angiotherapy.869746

Submitted: 22 April 2024 Revised: 15 July 2024  Published: 17 June 2024 

Abstract

Intraoperative neurophysiological monitoring (IOM) aims to minimize nerve pathway injuries during neurosurgical procedures. Understanding the impact of anesthetic drugs on IOM is crucial for anesthesiologists. IOM utilizes various electrophysiological methods such as brainstem auditory evoked potential (BAEP), visual evoked potential (VEP), electroencephalography (EEG), electromyography (EMG), motor evoked potential (MEP), and sensory/somatosensory evoked potential (SEP) to monitor the brain, spinal cord, and associated nerves. Different anesthetic agents, particularly inhaled ones, can significantly affect evoked potentials. This case report discusses a pediatric patient diagnosed with infratentorial SOL at the midcerebellum, suspected medulloblastoma, who underwent craniotomy tumor removal with IOM. The patient was induced with propofol, fentanyl, lidocaine, and dexmedetomidine, followed by maintenance using propofol and dexmedetomidine. The patient's hemodynamics remained stable throughout the 10-hour surgery, and there were no issues with IOM recordings. This case highlights the anesthetic challenges in pediatric craniotomy, emphasizing the importance of selecting appropriate anesthetic agents and techniques to maintain neurological function and hemodynamic stability. The successful use of total intravenous anesthesia (TIVA) with propofol, fentanyl, and dexmedetomidine demonstrates a viable approach for maintaining anesthesia depth without compromising IOM signals, underscoring the need for interdisciplinary collaboration in complex neurosurgical procedures.

Keywords: Intraoperative neurophysiological monitoring (IOM), Pediatric craniotomy, Anesthetic management, Medulloblastoma, Total intravenous anesthesia (TIVA)

References

Bruder, N., & Ravussin, P. A. (2010). Supratentorial masses: Anesthetic consideration. In J. Cottrell & M. Young (Eds.), Cottrell and Young’s Neuroanesthesia (5th ed.). Philadelphia, PA: Mosby Elsevier.

Gunes, Y., Turktan, M., Erman, T., Ozbek, H., & Isik, G. (2009, June). Anesthesia for craniotomy: Comparison of sevoflurane, desflurane, or isoflurane supplemented with an infusion of dexmedetomidine during supratentorial craniotomy. Neurosurgery Quarterly.

Jain, R. A., Shetty, A. N., Oak, S. P., Wajekar, A. S., & Garasia, M. B. (2017). Effects of avoiding neuromuscular blocking agents during maintenance of anesthesia on recovery characteristics in patients undergoing craniotomy for supratentorial lesions: A randomized controlled study. Indian Journal of Anaesthesia.

Jeker, S., Beck, M. J., & Thomas, O. (2022, October). Special anaesthetic considerations for brain tumour surgery in children. MDPI Journal.

Keown, T., Bhangu, S., & Solanki, S. (2022, February). Anesthesia for craniotomy and brain tumor resection. Introduction to Intraoperative Neurophysiological Monitoring for Anaesthetists. World Federation of Societies of Anaesthesiologists.

Korean Society of Intraoperative Neurophysiological Monitoring. (2020). Clinical practice guidelines for intraoperative neurophysiological monitoring: 2020 update. Annals of Clinical Neurophysiology.

Tomita, T., Alden, T. D., & Dipatri, A. J. (2022, July). Pediatric pineal region tumors: Institutional experience of surgical managements with posterior interhemispheric transtentorial approach. Child's Nervous System.

Winghay, H. Y., & Kwong, E. C. C. (2019, February). Introduction to intraoperative neurophysiological monitoring for anaesthetists. World Federation of Societies of Anaesthesiologists.

Xing, F., An, L. X., Xue, F. S., Zhao, C. M., & Bai, Y. F. (2019). Postoperative analgesia for pediatric craniotomy patients: A randomized controlled trial. BMC Anesthesiology.

You, H., & Qiao, H. (2021, June). Intraoperative neuromonitoring during resection of gliomas involving eloquent areas. Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China. Frontiers in Neurology.

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