Awake Craniotomy pada Biopsi Steriotaktik Tumor Supratentorial di daerah Thalamus Dextra et causa Suspect Thalamic Glioma

Abstract

Awake craniotomy merupakan suatu prosedur yang banyak digunakan pada kasus-kasus intrakranial dengan berbagai tujuan, yang memungkinkan dapat menentukan lokasi kelainan di otak yang akurat dan meminimalkan risiko cedera neurologis selama tindakan. Peran anaesthesiologist adalah untuk memberikan analgesia dan sedasi yang memadai sambil mempertahankan ventilasi dan stabilitas hemodinamik pada pasien yang sadar dan harus kooperatif selama tindakan berlangsung. Seorang wanita berusia 32 tahun dengan tumor supratentorial at region thalamus dextra et causa suspek thalamic glioma untuk dilakukan tindakan steriotaktik biopsi dengan Awake craniotomy. Pada pemeriksaan ditemukan keluhan sulit berjalan sejak 4 tahun karena sisi tubuh bagian kiri lemah, bicara cedal, mulut mencong ke kanan, kejang pada kepala dan mata sebelah kiri. Pasien dirujuk karena muntah hebat dan sakit kepala hebat 1 minggu terakhir, kesadaran komposmentis, GCS E4M6V5. Paresenerves VI kanan-kiri, parese nerves VII sinistra sentral. Pemeriksaan laboratorium, ECG dan foto thorak tidak didapatkan kelainan, sedangkan pada MSCT kepala didapat kan adanya massa berbatas tidak tegas, dinding tidak teratur dengan kalsifikasi minimal di thalamus kanan disertai edema perifokal kemungkinan suatu low grade astrocytoma dan hydrocephalus obstruksi. Tindakan biopsi steriotaktik terhadap tumor supratentorial ini dilakukan dengan tehnik anestesi awake craniotomy dengan obat dexmedetomidin, propofol dan fentanyl. Pengawasan pasien di ruang pemulihan selama 4 jam.Setelah Modified Aldrete score 9–10, pasien dipindahkan ke ruangan.

Awake Craniotomy in Stereotactic Biopsy for Supratentorial Tumors at Thalamus Dextra Region et causa Suspect Thalamic Glioma

Awake craniotomy is a procedure that is widely used in intracranial procedures with a variety purposes, which also allows an accurate localization of abnormalities in the brain, and to minimize the risk of neurological injury. Anaesthesiologist role is to provide adequateanalgesia and sedation while maintaining ventilation and hemodynamic stability in patients that still conscious and cooperative during the surgery. A 32years old woman with supratentorial tumor at theright thalamus with suspected thalamic glioma. Stereotactic biopsy was performed under awake craniotomy.She was sufferedwith difficulty in walking for 4 years due to weakness of the left side of the body,slurred talking, and lopsided mouth to the right, withspastic on the head and left eye. She was referred because of severe vomiting and headaches since 1 week, but still fully alert withGCS E4M6V5. She had bilateral nerve VI and central of left nerve VIIpareses. Her laboratory examinations, ECG and thoracic images were normal, whereas MSCT showeda mass with not firm verge, irregular wall with minimal calcification in the right thalamus and perifocaledema, suggested as a low grade astrocytoma and hydrocephalus obstruction. Stereotactic biopsy of supratentorial tumors was performed under awake craniotomy with dexmedetomidine, propofol and fentanyl. The patient was observed at the PACU for 4 hours, and after Modified Aldrete score reached 9–10, the patient was transferred to the ward.