Penatalaksanaan Anestesi untuk Operasi Tumor Fossa Posterior disertai Hidrosefalus

Abstract

Fossa posterior tumor removal procedure may have spesific problem including obstruction of cerebral spinal fluid pathway, development of hydrocephalus and an increased intracranial pressure. A 25 year old woman, 52 kgs, admitted to the hospital with major complaint of dizziness occurred approximatelly 5 hours prior to hospital admission. The patient also suffered from nausea, vomiting, buzzing hearings, and heartburn sensation. The non-contrast MSCT revealed a non-communicating hydrocephalus, tumor of the right cerebellar hemisphere, suspected as astrocytoma with differential diagnosis of medullablastoma. From axial, coronal and sagittal view of MSCT with contrast, a tumor mass was found in the posterior fossa, and most likely to be considered as a polycystic cerebellar astrocytoma with mild hydrocephalus. She was diagnosed with obstructive type of hydrocephalus and cerebellar tumor with increased intracranial pressure signs due to hydrocephalus, and planned for VP shunt prior to the tumor removal. To maintain brain perfusion as well as to ensure brain relaxation, anesthesia management was done with several methods such as hyperventilation, administration of mannitol 20%, while maintaining adequacy of MAP. The VP shunting was conducted in supine position, whilst the posterior fossa excision in conducted in prone position. Both procedures were done in 4.5 hours. Postoperative extubation was postponed until the following day at the intensive care unit. The patient was sedated and ventilated for 14 hours. No sign of venous air embolisms. Post extubation on the next day, the patient’s breathing and hemodynamic statuses were both stabile and adequate, with no significant neurological defect.

Keywords

• fossa posterior tumor
• hydrocephalus
• vp shunt
• prone position
• venous air embolisme