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Management of Patient with Supratentorial Tumor

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Problem Based Learning Discussions in Neuroanesthesia and Neurocritical Care

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Abstract

Supratentorial tumors account for approximately 80% of all brain tumors in adults and constitute the majority of neurosurgical conditions that present for craniotomy. The nature of the lesions varies from benign tumors like meningiomas, pituitary adenomas to highly malignant tumors like glioblastomas. An anesthesiologist may encounter a patient with a supratentorial tumor for an elective planned surgery, thus allowing adequate time for optimization or for an acute neurologic deterioration, requiring emergent intervention. Understanding supratentorial tumors’ pathophysiology and implications of their effects not only on the neurological system, but also on other bodily systems like the endocrine, is crucial for delivering a safe and optimal anesthetic. The perioperative goals for supratentorial tumor resection are to optimize cerebral perfusion, oxygenation, and operative conditions, bestow neuroprotection, facilitate rapid and smooth awakening for postoperative neurological evaluation, minimize postoperative pain, and improve the oncological outcomes. It is important to avoid any secondary systemic insults. An ideal anesthetic regimen should deliver adequate amnesia and analgesia while maintaining systemic and cerebral milieu along with reduction in CMR and ICP. The different stages of anesthesia, from induction to emergence, entail idiosyncrasies that calls for tailored medication delivery, special positioning and monitoring. Intracranial hypertension, brain edema, seizure, and sequelae of endocrinopathies like DI, SIADH, or CSW are features of some brain tumors that need to be considered as understanding of their effects can guide how and when hyperosmolar solutions, diuretics, steroids, antiepileptics, and/or colloids are administered.

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Authors and Affiliations

  1. Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA, USA

    Rashmi Vandse & Donna Lien

  2. Department of Neurologic Surgery, Loma Linda University, Loma Linda, CA, USA

    Promod Pillai

Authors
  1. Rashmi Vandse
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  2. Donna Lien
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  3. Promod Pillai
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Editors and Affiliations

  1. Department of Neuroanesthesiology & Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Hemanshu Prabhakar

  2. Vice chair for education & Associate Director of Neuroanesthesiology, Allegheny Health Network, Pittsburgh, PA, USA

    Shobana Rajan

  3. Department of Neuroanesthesiology & Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Indu Kapoor

  4. Department of Neuroanesthesiology & Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Charu Mahajan

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Vandse, R., Lien, D., Pillai, P. (2020). Management of Patient with Supratentorial Tumor. In: Prabhakar, H., Rajan, S., Kapoor, I., Mahajan, C. (eds) Problem Based Learning Discussions in Neuroanesthesia and Neurocritical Care. Springer, Singapore. https://doi.org/10.1007/978-981-15-0458-7_17

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