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

Understanding anesthetic effects on IOM is crucial for safe neurosurgical outcomes, especially in complex pediatric craniotomies.

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)

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