Neuromonitoring in a Case with Midbrain Cavernoma Operated in Sitting Position: Unveiling the Complexities
The sitting position is often utilized for mid-brain cavernoma excision due to its several surgical advantages. Intraoperative neuromonitoring aids dynamic functional assessment of neural structures in real-time. In this case report, we discuss the anesthetic management of a patient scheduled for mi...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2024-06-01
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| Series: | Journal of Neuroanaesthesiology and Critical Care |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0044-1786516 |
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| author | Joslita Rebello Bhoomika Thakore |
| author_facet | Joslita Rebello Bhoomika Thakore |
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| description | The sitting position is often utilized for mid-brain cavernoma excision due to its several surgical advantages. Intraoperative neuromonitoring aids dynamic functional assessment of neural structures in real-time. In this case report, we discuss the anesthetic management of a patient scheduled for midbrain cavernoma excision in a sitting position. Evoked potential monitoring was performed as the tumor was in proximity to cortico-spinal tracts. We used a combination of inhalational and intravenous anesthetics for the maintenance of anesthesia. Intraoperatively significant events included two episodes of venous air embolism, and loss of motor evoked potentials during the resection of the tumor. These complications were promptly recognized and managed. In the early postoperative period, the patient had motor power 3/5 in flexors of the right upper limb, which improved to normal by Day 5. Thus, good communication among anesthesiologists, neurologists, and surgeons helped identify altered evoked potential signals early, aiding the modification of dissection accordingly. |
| format | Article |
| id | doaj-art-e1ee4141f9484ea0b573d0c1aee797a9 |
| institution | OA Journals |
| issn | 2348-0548 2348-926X |
| language | English |
| publishDate | 2024-06-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Journal of Neuroanaesthesiology and Critical Care |
| spelling | doaj-art-e1ee4141f9484ea0b573d0c1aee797a92025-08-20T02:14:27ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Neuroanaesthesiology and Critical Care2348-05482348-926X2024-06-01110213613910.1055/s-0044-1786516Neuromonitoring in a Case with Midbrain Cavernoma Operated in Sitting Position: Unveiling the ComplexitiesJoslita Rebello0https://orcid.org/0009-0007-0265-1463Bhoomika Thakore1Department of Anesthesiology, P.D Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, IndiaDepartment of Anesthesiology, P.D Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, IndiaThe sitting position is often utilized for mid-brain cavernoma excision due to its several surgical advantages. Intraoperative neuromonitoring aids dynamic functional assessment of neural structures in real-time. In this case report, we discuss the anesthetic management of a patient scheduled for midbrain cavernoma excision in a sitting position. Evoked potential monitoring was performed as the tumor was in proximity to cortico-spinal tracts. We used a combination of inhalational and intravenous anesthetics for the maintenance of anesthesia. Intraoperatively significant events included two episodes of venous air embolism, and loss of motor evoked potentials during the resection of the tumor. These complications were promptly recognized and managed. In the early postoperative period, the patient had motor power 3/5 in flexors of the right upper limb, which improved to normal by Day 5. Thus, good communication among anesthesiologists, neurologists, and surgeons helped identify altered evoked potential signals early, aiding the modification of dissection accordingly.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0044-1786516midbrain cavernomasitting positionSSEPMEPvenous air embolism |
| spellingShingle | Joslita Rebello Bhoomika Thakore Neuromonitoring in a Case with Midbrain Cavernoma Operated in Sitting Position: Unveiling the Complexities Journal of Neuroanaesthesiology and Critical Care midbrain cavernoma sitting position SSEP MEP venous air embolism |
| title | Neuromonitoring in a Case with Midbrain Cavernoma Operated in Sitting Position: Unveiling the Complexities |
| title_full | Neuromonitoring in a Case with Midbrain Cavernoma Operated in Sitting Position: Unveiling the Complexities |
| title_fullStr | Neuromonitoring in a Case with Midbrain Cavernoma Operated in Sitting Position: Unveiling the Complexities |
| title_full_unstemmed | Neuromonitoring in a Case with Midbrain Cavernoma Operated in Sitting Position: Unveiling the Complexities |
| title_short | Neuromonitoring in a Case with Midbrain Cavernoma Operated in Sitting Position: Unveiling the Complexities |
| title_sort | neuromonitoring in a case with midbrain cavernoma operated in sitting position unveiling the complexities |
| topic | midbrain cavernoma sitting position SSEP MEP venous air embolism |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0044-1786516 |
| work_keys_str_mv | AT joslitarebello neuromonitoringinacasewithmidbraincavernomaoperatedinsittingpositionunveilingthecomplexities AT bhoomikathakore neuromonitoringinacasewithmidbraincavernomaoperatedinsittingpositionunveilingthecomplexities |