A Case of Large Frontal Lobe Meningioma Complicated by Massive Intraoperative Hemorrhage

Keywords

meningioma - thiopentone - vascular

Introduction: A 65-year-old female patient complained of swelling over left side of forehead and scalp for 1 year and protrusion of eyeball since 6 months. She was diagnosed as meningioma in left frontal lobe, with mass effect and midline shift. Meningioma forms on the meninges, often slow growing; 90% are benign. They occur more in women than in men.

Methodology/Description: The swelling increased over 6 months, causing proptosis, ptosis, and squint of left eye. She developed headache and nausea (1 month). There was altered sensorium, irrelevant speech, and slow mentation for 2 weeks. Glasgow Coma Scale (GCS)—14/15 (E₄ V₄ M₆). She was preoxygenated and was premedicated. Induction—inj. thiopentone 250 mg, inj. rocuronium 40 mg. Intubated with flexometallic tube. Maintained on O₂ + N₂O (1:1) and sevoflurane (1–2%) using controlled ventilation on closed circuit volume control mode. Muscle relaxation bolus doses of inj. rocuronium 1mg (for both surgeries). After first surgery, she was shifted to surgical intensive care unit (SICU), intubated in view of major blood loss, for 3 days on inotropes. Thereafter, she was weaned off ventilator, put on T-piece, and taken for external carotid artery ligation and excision of tumor (second surgery). At the end of second surgery, patient was reversed. She was obeying commands, eye opening was present, and tone and reflexes were normal. She was extubated on table. Phonation was present. Vitals were stable. Patient was shifted to SICU for observation. After 5 days in SICU, she was shifted to the general ward.

Conclusion: Meningioma is highly vascular brain neoplasms, associated with blood loss during resection. The anesthetic and perioperative care requires an understanding of pathophysiology of the tumor, effect of anesthetics, fluid therapy, and hemodynamics.

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