Manajemen Anestesi pada Kraniotomi Pengangkatan Tumor Meningioma dengan Riwayat Operasi Kliping Aneurisma: Studi Kasus

Abstract

The co-existence of brain tumors with cerebral aneurysms is extremely rare, with an estimated incidence of 0,5-4,5%. The priority for surgical treatment of these two pathologies is not clear, where surgery on a cerebral aneurysm is sometimes performed initially before surgical removal of brain tumor. Treatment of brain tumors in patients with a history of clipping aneurysm has its own challenges in the field of anesthesia, where anesthetic action has the goal of reducing the risk of aneurysm rupture, preventing cerebral ischemia, and optimizing systemic function while facilitating surgical procedures. This case study reports on a 58-year-old woman who underwent surgical removal of a meningioma tumor with a history of aneurysm clipping. Aneurysm clipping surgery was performed 3 months before brain tumor removal. Patient with clinical headache and blurred vision in the right eye, without other neurological deficits. Anesthetic management is carried out with the target of preventing further increase in intracranial pressure, with adequate analgesia, proper brain relaxation techniques, and prevention of hypercapnia, hypocapnia, and hypoxia. In addition, blood pressure must be maintained by preventing hypotension or hypertension. At the end of the operation, the patient was extubated and transffered to the intensive care unit. On postoperative examination the patient was conscious, without seizures, and without neurological deficits.