Seksio sesarea dengan anestesi spinal pada pasien tumor otak: Sebuah laporan kasus
- PDF |
- DOI: https://doi.org/10.15562/medicina.v50i2.618 |
- Published: 2019-05-02
Open Access & Peer Reviewed
Multidisciplinary Medical Journal
Multidisciplinary Medical Journal
Abstract
Neoplasma intrakranial bervariasi dalam insidens, histologi, presentasi klinis, dan prognosis. Neoplasma otak pada wanita hamil terjadi dengan frekuensi relatif yang sama seperti pada wanita non hamil. Seorang wanita hamil berusia tiga puluh lima tahun dengan tumor otak yang di curigai meningioma clivus dibawa ke Departemen Kebidanan untuk dipersiapkan menjalani bedah caesar elektif. Pada Magnet Resonance Imaging (MRI) terbaru, dilakukan satu bulan sebelum persalinan, dimensi tumor adalah +/- 23,13 x 20,67 mm di ekstra aksial dengan broadbase di kanan clivus dan mendorong sisi kanan pons tanpa tanda-tanda dilatasi ventrikel IV. Kami memutuskan untuk melakukan operasi di dengan anestesi spinal karena tidak ada gejala neurologis baru (misalnya, sakit kepala yang memburuk, perubahan visual, kejang, atau penurunan tingkat kesadaran) atau lesi yang diketahui yang cenderung tumbuh atau berubah selama kehamilan, tidak ada bukti pencitraan terjadi efek massa yang signifikan tanpa pergeseran garis tengah, tidak ada bukti hidrosefalus dan tidak ada temuan klinis atau pencitraan yang menunjukkan peningkatan tekanan intrakranial. Blok spinal dilakukan dengan jarum spinal 27 G bevel quincke, di ruang intervertebral L2-L3, dengan bupivakain hiperbarik 0,5% 7,5 mg. Anestesi regional dengan spinal anestesi dapat dilakukan dengan aman untuk pasien ini.
Â
Intracranial neoplasms vary in incidence, histology, clinical presentation, and prognosis. Brain neoplasms in pregnant women appear to occur with the same relative frequency as in non-pregnant women. A thirtyfive-years-old pregnant woman with a brain tumor suspected clivus meningioma was admitted to the obstetric department to be prepared for elective c-section. On the most recent magnet resonance imaging (MRI), performed one month before her delivery, the dimensions of the tumor were +/- 23.13 x 20.67 mm in extra axial with broad-based in right clivus and pushed the right side of pons with no sign of ventricle IV dilatation. We decided to perform the operation under spinal anesthesia because of there aren’t new neurologic symptoms (worsening headache, visual changes, seizure, or decreased level of level of consciousness) or a known lesion that is likely to grow or change during pregnancy, there isn’t imaging evidence of significant mass effect with or without midline shift, there isn’t imaging evidence of hydrocephalus and there isn’t clinical or imaging findings suggest increased intracranial pressure. Spinal block was performed with spinal needle 27 gauge Quinckie, at the lumbal 2-3 intervertebral space, with hyperbaric bupivacaine 0,5% 7,5 mg. Regional anesthesia with Spinal Anesthesia can perform safely to this patient.
References
- Bader AM. Neurologic and neuromuscular disease dalam Chesnut DH et al penyunting. Chesnut’s obstetric anesthesia. Edisi ke-5. Philadelphia: Elsevier Saunders ; 2014. H. 1129-31
- Sahu S, Swain A. Optic nerve sheath diameter : a novel way to monitor the brain. J Neuroanesthesiol Crit Care 2017;4 : S13-8
- Komut E, et al. Bedside sonographic measurement of optic nerve sheath diameter as a predictor of intracranial pressure in ED, Am J Emerg Med (2016), http://dx.doi.org/10.1016/j.ajem.2016.02.012
- Du Toit, GJ, Hurter, D, Nel, M. How accurate is ultrasound of the optic nerve sheath diameter performed by inexperienced operators to exclude raised intracranial pressure?. S Afr J Rad. 2015;19(1); Art. #745, 5 pages. http://dx.doi. org/10.4102/sajr.v19i1.745
- Wlody DJ, Gambling DR, Griffiths TL. Anesthesia for neurosurgery in the pregnant patient dalam Cottrell JE et Patel P penyunting. Cottrell and Patel’s Neuroanesthesia. edisi ke-6. New York : Elsevier; 2017. H. 439-40
- Leffert LR, Schwamm LH. Neuraxial Anesthesia in Parturients with Intracranial Pathology A Comprehensive Review and Reassessment of Risk. Anesthesiology V 2013; 119 : 703-18
- Toledano RD, Van de Velde M. Epidural anesthesia and analgesia dalam Hadzic A penyunting. The new york school of regional anesthesia hadzic’s textbook of regional anesthesia and acute pain management. Edisi ke-2. New york : McGrawHill education ; 2017. h. 389-90.
How to Cite
Syamsuddin, J. B. T., & Jaya Sutawan, I. B. K. (2019). Seksio sesarea dengan anestesi spinal pada pasien tumor otak: Sebuah laporan kasus. Medicina, 50(2). https://doi.org/10.15562/medicina.v50i2.618
