Anestesi untuk Malformasi Arnold Chiari

Abstract

Malformasi Arnold-Chiari, merupakan suatu bentuk malformasi pada otak. Pada malformasi ini terjadi pergeseran (displasi) tonsila serebelum ke arah bawah melalui foramen magnum (lubang di basis kranii), yang terkadang menyebabkan hidrosefalus non-komunikans sebagai akibat terjadinya obstruksi aliran keluar dari cairan serebrospinal. Seorang wanita 23 tahun datang dengan keluhan sering pusing, nyeri tengkuk, serta kelemahan pada lengan kanan. CT Scan dan MRI didapatkan gambaran cerebellar tonsil yang mendukung Arnold Chiari Malformation. Dilakukan operasi osteotomi suboccipital dengan posisi prone. Rumatan anestesi dengan sevoflurane 1 vol% dan O2: udara 1,5: 1,5, analgetik fentanyl 25 mcg tiap 30 menit, pelumpuh otot vecuronium 3 mg/jam. Operasi berlangsung selama 2 jam 45 menit. Hemodinamik selama operasi stabil. Dilakukan ekstubasi segera di kamar operasi. Pascaoperasi pasien dirawat di unit intensif selama sehari. Hemodinamik selama di ICU stabil. Tidak ada keluhan selama di ICU

Anesthesia for Arnold Chiari Malformation

Arnold-Chiari's malformation, is a brain malformation caused by the displacement of the cerebellar tonsil caudally into the foramen magnum, which in some cases will cause obstruction of the cerebrospinal fluid flow, resulting in a communicating hydrocephalus condition. A 23 years old female patient with a chief complaint of having frequent dizzines, painful neck, and weakness of the right arm. CT scan and MRI reveal cerebellar tonsil imaging that support the diagnosis of Arnold-Chiari's malformation. Surgical procedure was performed using suboccipital osteotomy approach in a prone position. Maintenance anesthesia with sevoflurane 1 vol% and O2: air 1,5: 1,5, analgetic fentanyl 25 mcg every 30 minute, muscle relaxant vecuronium 3 mg/hour. The time of surgery was 2 hours and 45 minutes. Hemodynamics were stable during the procedure. Patient was extubated early after surgery at operating room, and admitted to the ICU for 24 hours. Hemodynamics parameter were stable, without any remarkable events.