Pembedahan Tumor Cerebellopontine Angle: Tehnik Proteksi Otak, Pengawasan Sistem Kardiorespirasi dan Efek Manipulasi Posisi True Lateral

Buyung Hartiyo Laksono

Abstract


Tumor cerebellopontine angle (CPA) merupakan jenis neoplasma terbanyak yang ditemukan di fossa posterior. Wanita 32 tahun dengan diagnosa CPA tumor dilakukan pembedahan trepanasi reseksi. Posisi pembedahan true lateral. Tehnik anestesi proteksi otak menggunakan kombinasi total intra vena (TIVA) dan inhalasi. Dilakukan pemasangan pengawasan invasif untuk memantau perubahan sistem kardiorespirasi selama pembedahan. Dilakukan pencegahan dan pemantauan terhadap akibat dari posisi pembedahan. Hasil dari pembedahan didapatkan pengurangan skala nyeri dan peningkatan fungsi neurologis. Tindakan pembedahan pada tumor di daerah CPA merupakan tindakan pembedahan yang sulit dan dapat menimbulkan komplikasi yang fatal. Pengelolaan anestesi untuk tindakan bedah fossa posterior memerlukan pertimbangan yang matang dan sudah ditentukan sebelum dilakukan anestesi. Persiapan pada pasien dengan lesi fossa posterior adalah evaluasi prabedah, premedikasi, induksi, posisi durante, pengelolaan anestesi dan monitoring. Manipulasi selama pembedahan pada batang otak dan saraf kranialis akan menimbulkan akibat pada sistem kardiorespirasi dan dapat fatal. Posisi true lateral mempunyai resiko tersendiri terhadap pasien selama dan pascapembedahan, hal tersebut harus menjadi perhatian khusus oleh ahli anestesi. Anestesi mempunyai peranan yang sangat penting dalam manajemen secara keseluruhan pada pasien ini untuk memberikan manajemen proteksi otak yang maksimal selama pembedahan sehingga memperoleh hasil akhir pembedahan yang sukses.

 

Cerebellopontine Angle Tumor Surgery: Brain Protection Techniques, Cardiorespiratory System Monitoring and True Lateral Position Manipulation Effects

Abstract

Cerebellopontine angle (CPA) tumors are the most common neoplasm found in the posterior fossa. A 32-year-old woman diagnosed with CPA tumor underwent resection. The surgery position is true lateral. Brain protection anesthetic techniques use total intravenous (TIVA)-inhalation combination. Invasive monitoring is performed to monitor the cardiorespiratory system during surgery. Prevention and monitoring are done to manage the effect of surgical position. There is a reduction in pain scale and increased neurological function after the surgery. CPA tumor surgery is a difficult procedure and potentially cause fatal complications. The anesthesia management for posterior fossa surgery must be determined before anesthesia. The surgery preparation for posterior fossa lesions-patients consists of surgery evaluation, premedication, induction, durante position, anesthesia management, and monitoring. The brainstem and cranial nerve surgery cause a fatal complication in the cardiorespiratory system. The true lateral position impact the patients' condition during and after surgery. Anesthesia is important to provide maximum brain protection and successful surgery.


Keywords


cerebellopontine angle; fossa posterior; posisi true lateral; proteksi otak; cerebellopontine angle; brain protection; fossa posterior; true lateral position

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References


American Brain Tumor Association. Brain tumor statistics. Chicago: 2012. Diakses dari http://www.abta.org/about-us/news/brain-tumor-statistics

McCarthy BJ, Surawicz T, Bruner J, Kruchko C. Consensus conference on brain tumor. Neuro-Oncology 2002: 134–45.

Swieszewska I, Szurowska E, Kloc W, Dubaniewicz WM, Skorek A, Drozynska E, Stempniewcz M. Cerebellopontine angle tumours: radiologic-pathologic correlation and diagnostic difficulties. Folia Neuropathol 2006; 44: 274–81.

Hain TC. Acoustic Neuroma. 2014. Diakses dari http://www.dizziness-and-balance.com/disorders/tumors/acoustic_neuroma.htm

Khaled A, Ahsan S, Joarder MA, Karim B, Chandy MJ, Nasir TA. Chondroma of the cerebellopontine angle: a case report. Pulse 2015; 8: 81–4.

Holanda A. Schwannoma and meningioma association of cerebellopontine angle. Neurocirurgica de Chile 2013; 39: 170–71.

Springborg JB, Poulsgaard L, Thomsen J. Nonvestibular schwannoma tumors in the cerebellopontine angle: a structured approach and management guidelines. Skull Base 2008; 18: 217–27.

Gonzales MF. Classification and pathogenesis of brain tumors. Churchill Livingstone: New York; 1995, 31–45.

Berger MS, Prado MD. Textbook of Neuro-Oncology. Elsevier Saunders: Pennsylvania; 2005.

Harijono B, Saleh CS. Tata kelola anestesi pada bedah fossa posterior. Jurnal Neuroanestesia Indonesia 2012; 1(4): 311–19.

Patel SJ, Wen DY, Haines SJ. Posterior fossa: surgical consideration. Dalam: Cottrell JE, Smith DS, eds. Anesthesia and Neurosurgery, 4th Ed, Missouri; Mosby, Inc: 2001, 319–33.

Schubert A. Positioning injuries in anesthesia: an update. Advances in Anesthesia 2008; 26: 31–65.

Saleh CS. Sinopsis Neuroanestesia Klinik. Surabaya: Universitas Airlangga Pers; 201.

Gheorghita E, Ciurea J. Considerations on anesthesia for posterior fossa-surgery, Romanian Neurosurgery, Emergency Hospital Bagdasar Arseni, Bucharest; 2012, XIX 3: 183–92.

Smith DS. Anesthetic management for posterior fossa surgery: Dalam Cotrell JE, Young WL, eds. Cottrel and Young’s Neuroanesthesia, 5th Ed, Philadelphia: Mosby, Inc; 2010, 203–7.

Goldsack C. Posterior fossa surgery: Dalam Gupta AK, Summors A, eds. Notes in Neuroanesthesia and Critical Care, edisi-1. London: Greenwich Medical Media. Ltd; 2001, 57–60.

Lalenoh D, Bisri T, Yusuf I. Brain protection effect of lidocaine measured by interleukin-6 and phospholipase A2 concentration in epidural haematoma with moderate head injury patient. J Anesth Clin Res 2014; 5(3): 1–3.

Menon G, Nair S, Bhattacharya RN. Cerebral protection – Current concepts. IJNT 2005; 2(2): 67–9.

William FC. Management of suprasellar meningioma. J Neuro-Ophthalmology 2003; 23(1): 1–2.

Bisri T. Dasar-Dasar Neuroanestesi, edisi ke-2. Bandung: Saga Olah Citra; 2008, 1–74.




DOI: https://doi.org/10.24244/jni.v8i3.217

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DOI:  https://doi.org/10.24244/jni 

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