NEUROANESTHESIA MANAGEMENT IN POSTERIOR FOSSA PILOCYTIC ASTROCYTOMA SURGERY

Abstract

Pilocytic astrocytoma is a low-grade benign brain tumor commonly found in children and young adults. Although its clinical course is generally favorable, atypical presentations may lead to diagnostic challenges and delays in management. This case report describes the diagnostic process and neuroanesthetic considerations in a young adult patient with an infratentorial pilocytic astrocytoma presenting with unusual symptoms. A 19-year-old male presented with nausea, hematemesis, and headache, which later progressed to status epilepticus. An initial abdominal computed tomography (CT) scan revealed no abnormalities; however, subsequent brain CT and magnetic resonance imaging (MRI) demonstrated a large cystic mass with a solid component in the infratentorial region, resulting in non-communicating hydrocephalus. The patient was diagnosed with suspected pilocytic astrocytoma and underwent ventriculoperitoneal (VP) shunt placement to manage increased intracranial pressure (ICP). Definitive tumor resection was postponed due to elevated liver function parameters requiring stabilization. The patient subsequently underwent posterior fossa craniotomy and tumor excision under propofol-based total intravenous anesthesia (TIVA). Neuroanesthetic management focused on maintaining cerebral perfusion, controlling ICP, preserving hemodynamic stability, and minimizing the risk of complications associated with posterior fossa surgery, including venous air embolism and pneumocephalus. Invasive arterial blood pressure monitoring was performed, and intraoperative hemodynamic parameters remained stable without evidence of increased ICP. The patient was successfully extubated in the operating room due to adequate consciousness and respiratory function. Postoperative recovery was uneventful, and the patient was discharged after four days. Histopathological examination confirmed pilocytic astrocytoma. This case emphasizes the importance of recognizing atypical manifestations of infratentorial pilocytic astrocytoma and demonstrates that propofol-based TIVA can provide effective ICP and hemodynamic control during complex neuroanesthetic.