Intraoperative neuromonitoring of visual evoked potentials in a pregnant patient with meningioma: a case report.
Pregnant
Remimazolam
Visual evoked potentials
Journal
BMC neurology
ISSN: 1471-2377
Titre abrégé: BMC Neurol
Pays: England
ID NLM: 100968555
Informations de publication
Date de publication:
25 Oct 2024
25 Oct 2024
Historique:
received:
29
05
2024
accepted:
08
10
2024
medline:
26
10
2024
pubmed:
26
10
2024
entrez:
25
10
2024
Statut:
epublish
Résumé
Meningioma in the parasellar region may lead to visual impairment, so intraoperative neurological monitoring is essential for enucleation surgery. However, intraoperative neurological monitoring in pregnant women is challenging, as the anesthesia management must consider the effects and risks to the fetus. Remimazolam is a newly introduced intravenous anesthetic that has little effect on blood pressure. However, the effects of remimazolam on intraoperative neuromonitoring are little known. We treated a pregnant patient with parasellar meningioma who developed visual impairment, using remimazolam for anesthesia and intraoperative neurophysiological monitoring of the visual evoked potential. A 34-year-old woman who was 20 weeks pregnant presented with visual acuity disturbances. Neuroimaging demonstrated a parasellar meningioma, and rapid tumor growth and worsening of symptoms subsequently occurred. Craniotomy for tumor removal was performed under anesthesia with remimazolam, which allowed monitoring of the visual evoked potentials. Her visual acuity was restored postoperatively, and no adverse events occurred in the fetus. Our experience with intraoperative neuromonitoring of a pregnant woman in the third trimester showed that anesthesia with remimazolam allows safe brain surgery combined with intraoperative visual evoked potential monitoring. Further research is needed to determine the effects of remimazolam on the fetus, as well as the safe dosage and duration of exposure.
Sections du résumé
BACKGROUND
BACKGROUND
Meningioma in the parasellar region may lead to visual impairment, so intraoperative neurological monitoring is essential for enucleation surgery. However, intraoperative neurological monitoring in pregnant women is challenging, as the anesthesia management must consider the effects and risks to the fetus. Remimazolam is a newly introduced intravenous anesthetic that has little effect on blood pressure. However, the effects of remimazolam on intraoperative neuromonitoring are little known. We treated a pregnant patient with parasellar meningioma who developed visual impairment, using remimazolam for anesthesia and intraoperative neurophysiological monitoring of the visual evoked potential.
CASE PRESENTATION
METHODS
A 34-year-old woman who was 20 weeks pregnant presented with visual acuity disturbances. Neuroimaging demonstrated a parasellar meningioma, and rapid tumor growth and worsening of symptoms subsequently occurred. Craniotomy for tumor removal was performed under anesthesia with remimazolam, which allowed monitoring of the visual evoked potentials. Her visual acuity was restored postoperatively, and no adverse events occurred in the fetus.
CONCLUSION
CONCLUSIONS
Our experience with intraoperative neuromonitoring of a pregnant woman in the third trimester showed that anesthesia with remimazolam allows safe brain surgery combined with intraoperative visual evoked potential monitoring. Further research is needed to determine the effects of remimazolam on the fetus, as well as the safe dosage and duration of exposure.
Identifiants
pubmed: 39455945
doi: 10.1186/s12883-024-03915-6
pii: 10.1186/s12883-024-03915-6
doi:
Substances chimiques
Benzodiazepines
12794-10-4
remimazolam
7V4A8U16MB
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
414Informations de copyright
© 2024. The Author(s).
Références
Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. J Neurooncol. 2010;99(3):307–14. https://doi.org/10.1007/s11060-010-0386-3 .
doi: 10.1007/s11060-010-0386-3
pubmed: 20821343
pmcid: 2945461
Hortobágyi T, Bencze J, Murnyák B, Kouhsari MC, Bognár L, Marko-Varga G. Pathophysiology of meningioma growth in pregnancy. Open Med (Wars). 2017;12:195–200. https://doi.org/10.1515/med-2017-0029 .
doi: 10.1515/med-2017-0029
pubmed: 28744488
Giraldi L, Lauridsen EK, Maier AD, Hansen JV, Broholm H, Fugleholm K, et al. Pathologic characteristics of pregnancy-related meningiomas. Cancers (Basel). 2021;13(15):3879. https://doi.org/10.3390/cancers13153879 .
doi: 10.3390/cancers13153879
pubmed: 34359779
Carbone L, Somma T, Iorio GG, Vitulli F, Conforti A, Raffone A, et al. Meningioma during pregnancy: what can influence the management? A case series and review of the literature. J Matern Fetal Neonatal Med. 2022;35(25):8767–77. https://doi.org/10.1080/14767058.2021.2004585 .
doi: 10.1080/14767058.2021.2004585
pubmed: 34822317
Laviv Y, Ohla V, Kasper EM. Unique features of pregnancy-related meningiomas: lessons learned from 148 reported cases and theoretical implications of a prolactin modulated pathogenesis. Neurosurg Rev. 2018;41(1):95–108. https://doi.org/10.1007/s10143-016-0762-3 .
doi: 10.1007/s10143-016-0762-3
pubmed: 27312026
Hayashi H, Kawaguchi M. Intraoperative monitoring of flash visual evoked potential under general anesthesia. Korean J Anesthesiol. 2017;70(2):127–35. https://doi.org/10.4097/kjae.2017.70.2.127 .
doi: 10.4097/kjae.2017.70.2.127
pubmed: 28367282
pmcid: 5370309
Pastor J, Pulido P, López A, Sola RG. Monitoring of motor and somatosensory systems in a 26-week pregnant woman. Acta Neurochir (Wien). 2010;152(7):1231–4. https://doi.org/10.1007/s00701-009-0585-x .
doi: 10.1007/s00701-009-0585-x
pubmed: 20084411
Guerrero-Domínguez R, González-González G, Rubio-Romero R, Federero-Martínez F, Jiménez I. [Anaesthetic management of excision of a cervical intraspinal tumor with intraoperative neurophysiologic monitoring in a pregnant woman at 29 weeks]. Rev Esp Anestesiol Reanim. 2016;63(5):297–300. https://doi.org/10.1016/j.redar.2015.07.001 . Spanish.
doi: 10.1016/j.redar.2015.07.001
pubmed: 26275733
Manohar N, Palan A, Manchala RK, Manjunath ST. Monitoring intraoperative motor-evoked potentials in a pregnant patient. Indian J Anaesth. 2019;63(2):142–3. https://doi.org/10.4103/ija.IJA_716_18 .
doi: 10.4103/ija.IJA_716_18
pubmed: 30814753
pmcid: 6383471
Kawaguchi K, Akeda K, Takegami N, Kurata T, Toriyabe K, Ikeda T, et al. Cervical schwannoma in the early stage of pregnancy: a case report. BMC Surg. 2020;20(1):245. https://doi.org/10.1186/s12893-020-00903-8 .
doi: 10.1186/s12893-020-00903-8
pubmed: 33081764
pmcid: 7576856
Tyagi M, Bir M, Sharma A, Singh PK, Bindra A, Chandra PS. Intraoperative neuromonitoring for spinal surgery in a pregnant patient: Case Report and Literature Review. Neurol India. 2022;70(Supplement):S314–7. https://doi.org/10.4103/0028-3886.360931 .
doi: 10.4103/0028-3886.360931
pubmed: 36412388
Yamada S, Hayamizu K, Akiyama Y, Kimura Y, Hashimoto S, Mikuni N, et al. Effect of remimazolam on intraoperative neurophysiology monitoring of visual-evoked potential: a case series. J Anesth. 2023;37(2):311–4. https://doi.org/10.1007/s00540-022-03159-z .
doi: 10.1007/s00540-022-03159-z
pubmed: 36602625