Management of Intracranial Pressure Control in Reciprocal Grade 3 Astrocytoma Patient In Dr. Moewardi General Hospital Surakarta: Case Report

Eko Setijanto,Teddy Wijaya

doi:10.20961/soja.v1i2.49731

Abstract

Surgery in patients with astrocytoma is performed based on the size of the tumor in the brain and the functional status of the patients. Management of patients with intracranial hypertension can be guided by monitoring intracranial pressure (ICP) perioperatively. A variety of ventricular, intraparenchymal, and subdural equipment can be installed by neurosurgeons to provide ICP measurements.We reported a 50-year-old female patient, with a complaint of having a speech disorder since four years ago. Preoperative physical examination showed GCS E4V5M6, patient's body mass index was 29.29 kg/m2 (obese). Patient’s physical status was assessed with ASA 3. There was no significant abnormality in laboratory examination. MRI Brain contrast examination showed solid cystic lesion in supratentorial left temporal lobe with size 2.3x3.5x4.7cm accompanied by broad perifocal edema in the left frontal, temporal and parietal lobe. The chest X-ray showed cardiomegaly and pneumonia. Electrocardiography showed normal sinus rhythm.Craniotomy in patients with astrocytoma is performed based on the size of the tumor in the brain and the functional status of the patient. Preoperative evaluation for patients undergoing craniotomy should be carried out to determine the presence or absence of intracranial hypertension. In principle, postoperative management in the ICU is to control the respiratory system, optimize the cardiovascular system, and prevent possible complications.Management of intracranial pressure control in reciprocal grade 3 astrocytoma patient should be paid attention to various things and consider the condition of the patients. Preoperative preparations, as well as perioperative and postoperative monitoring, should be carefully observed to prevent complications that will adversely affect patients.

Highlights

Intracranial mass may be congenital, neoplastic, infectious, or vascular.[1]Craniotomy is commonly performed for brain neoplasms
Surgery in patients with astrocytoma is performed based on the size of the tumor in the brain and the functional status of the patients.[3]
Management of patients with intracranial hypertension can be guided by monitoring intracranial pressure (ICP) perioperatively.[4]

Summary

INTRODUCTION

Intracranial mass may be congenital, neoplastic (benign or malignant), infectious (abscesses or cysts), or vascular (hematoma or arteriovenous malformations).[1]. Surgery in patients with astrocytoma is performed based on the size of the tumor in the brain and the functional status of the patients.[3] Patients with tumors located in vital centers with hemiparesis, dysphasia/aphasia, elderly patients are not an indication for surgery.[4]. The role of surgery is to decompress the tumor mass and take the tissue for histopathological examination, so that adjuvants treatment can be planned and estimate the prognosis.[4]. Patients have a history of tumor excision craniotomy in August 2018 (GA-ET). The patient has a history of surgery on the head 1 year ago at Dr Moewardi Surakarta General Hospital. Patients have no history of hypertension and diabetes mellitus. Physical Examination From the physical examination, it was found GCS E4V5M6, patient's body mass index was 29.29 kg/m2 (obese), other vital signs were within normal limits.

Supporting Examination

Postoperative Management

Findings

CONCLUSION