P037: ANESTHETIC MANAGEMENT OF HEMANGIOBLASTOMA RESECTION IN A 22 WEEK PREGNANT 26 YEAR OLD FEMALE
Harshvardhan Rajen, MD; James Morrow, MD; Carlos Rodriguez, MD; Kendall Regional Medical Center
Introduction: The patient is a 26 year old female with a past medical history of ongoing headache for 1 month, and 22 weeks and 1 day pregnant. Patient underwent brain MRI which revealed a 3.0x2.9x2.4 cm cystic mass in the right cerebellar hemisphere with enhancing mural nodule, the findings of which were highly suspicious for hemangioblastoma given patient age and radiographic appearance. The consultants during this patient's case were OB/GYN, neonatology, neurosurgery, neurology, and anesthesiology. As part of preoperative evaluation, the fetus was deemed to be at a nonviable age and as such was monitored only with pre- and post- operative fetal heart rate. The decision was made to proceed with resection of the tumor.
Methods: The patient underwent general anesthesia, and post induction a right internal jugular central venous catheter was placed in order to aspirate a venous air embolism which is a possible risk for this type of surgery. She as well had a large bore IV placed and an arterial line for continuous hemodynamic monitoring. Total intravenous anesthetics were used during the procedure, and general anesthesia was maintained with an infusion of propofol and remifentanil.
Results: The tumor was successfully resected and the patient monitored in the intensive care unit post-operatively and was discharged home on post operative day 6. The pathology results confirmed the cystic mass was indeed a hemangioblastoma.
Discussion: There are several anesthetic considerations involved due to the complexity of this case. Due to the fact the patient is pregnant, certain medications were avoided due to the possible teratogenic effect on the developing fetus, as well as the hemodynamic instability that may occur during manipulation of the tumor. Another complication that may occur is bleeding and blood loss due to the tumor having a feeding vessel that is a branch from the posterior inferior cerebellar artery. Maintaining cerebral perfusion during this procedure is a delicate balance, couple with also maintaining adequate placental perfusion for the fetus.