Anesthetic approach for removal of brain tumor with coexistent cerebral aneurysm

Delipetrova, Natali and Lazarevski, Martin and Mihailov, Marjan and Eftimova, Biljana (2024) Anesthetic approach for removal of brain tumor with coexistent cerebral aneurysm. In: VII Macedonian congress of anaesthesiology, reanimation and intensive care medicine, 04-07 Apr 2024, Ohrid, N. Macedonia.

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Abstract

Introduction; Primary brain tumors associated with intracranial aneurysm are rare. A combination of glioblastoma multiforme (GBM) with cerebral aneurysm is even more rare. Objectives; Our aim is to point out the specifics in anesthesia management in this case where two coexisting neurosurgical pathologies are present. Material and methods; Case of a 71-year-old male, admitted of removal of a brain tumor, most likely glioblastoma multiforme. Imaging scans – CT and MRI confirmed a mass with the size of 31x27 mm, located in the occipital region of the brain, with mild brain oedema. Along with the brain mass, the patient had an unruptured aneurysm of the anterior communicating artery. The patient was also previously operated on for an abdominal aortic aneurysm. On admission, he was somnolent, confused and dysphasic. Results Prior to the operation, a central venous line was placed in the right femoral vein and the patient was premedicated with benzodiazepines. The surgical intervention was done under general anesthesia with propofol, remifentanil, sevoflurane and rocuronium. Intraoperatively, to reduce the brain oedema, Mannitol 20% and dexamethasone were administered. During the surgery, the patient was hemodynamically stable and had no great blood loss. Apart from receiving crystalloids, the patient was substituted with 3 units of fresh frozen plasma. In advance, the patient also was administered tranexamic acid. Conclusion; The main goal of the anesthetic management in this case was to prevent variations in the arterial blood pressure and cerebral perfusion pressure, ultimately decreasing the possibility of rupturing the aneurysm. The choice of anesthetic agents to achieve this effect is essential and must be taken into account prior to the surgical procedure. Keywords; brain tumor; cerebral aneurysm; anesthetics.

Item Type:	Conference or Workshop Item (Poster)
Subjects:	Medical and Health Sciences > Clinical medicine
Divisions:	Faculty of Medical Science
Depositing User:	Assoc.Prof Biljana Eftimova
Date Deposited:	26 Aug 2024 07:26
Last Modified:	26 Aug 2024 07:26
URI:	https://eprints.ugd.edu.mk/id/eprint/34474

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