Anesthesia for suboccipital craniotomy in a patient with lymphangioleiomyomatosis: a case report

Abstract

Lymphangioleiomyomatosis (LAM) is a rare pulmonary condition often presenting with spontaneous pneumothorax. Imaging or biopsy confirm the diagnosis. Published case reports describe the anesthetic management of patients with LAM undergoing brief procedures. No reports describe the anesthetic management for lengthy neurosurgical procedures. We describe anesthetic management for craniotomy in a patient with LAM. Clinical Features. A woman presented with 2 spontaneous left pneumothoraces. She received a diagnosis of LAM by imaging. She did well after pleurodesis. Hearing loss and tinnitus led to brain imaging demonstrating a large left cerebello-pontine angle mass. She presented for elective craniotomy to remove the mass while preserving cranial nerve function. Our technique for general endotracheal anesthesia aimed to reduce the likelihood of another pneumothorax while providing good surgical conditions and permitting neuromonitoring. Conclusion. We demonstrate the successful anesthetic management of a patient with LAM undergoing a lengthy suboccipital craniotomy for a posterior fossa mass.

Figure 1

Preoperative axial and coronal MRI images of the patient's brain. Gadolinium enhancement demonstrates a large mass in the left cerebello-pontine angle.

Figure 2

Screen shot of intraoperative ventilator parameters and measurements. The image depicts fresh gas flows, expired and inspired concentrations of isoflurane, airway pressures and flows, and expired CO₂ tracings. Tidal volume was set at approximately 6 mL/kg. The anesthesia machine was an Apollo from Dräeger (Pittsburgh, PA).