The efficacy of SURGIFLO® in management of sub-arachnoid hemorrhage after cerebello-pontine (CP) angle schwannoma surgery- A case report

Document Type : Case report

Authors

1 Department of Neuroanesthesia cell, Indira Gandhi Medical college and hospital, Shimla, Himachal Pradesh, India.

2 Department of Anesthesia, Indira Gandhi Medical college and hospital, Shimla, Himachal Pradesh, India.

3 Department of Neurosurgery, Indira Gandhi Medical college and hospital, Shimla, Himachal Pradesh, India.

4 Department of Radiodiagnosis Neuroradiology Cell, Indira Gandhi Medical college and hospital, Shimla, Himachal Pradesh, India.

Abstract

Background: Subarachnoid hemorrhage (SAH) as a complication after cerebello-pontine (CP) angle surgery has rarely been described in literature. We intended to cite the preceding scenario leading to this event and its successful management based on anesthetic and surgical directed approach. Case presentation: A middle aged female patient presenting with complaints of hearing loss, vertigo and swaying gait underwent surgery for cystic vestibular schwannoma under cranial nerve monitoring. The anesthetic maintenance was solely based on entropy guided propofol infusion. Intra-operatively the patient suffered hemorrhage during the tumor decompression, which was eventually stopped after usage of SURGIFLO. Post-operatively, the neuro-imaging revealed SAH. It was managed in ICU on the lines of prevention of vasospasm and patient was subsequently discharged from the institute. Conclusions: SURGIFLO is effective in control of intra-operative grade 3 bleed. Nimodipine usage is indispensible for management of vasospasm. Maintenance of hemodynamics during the crisis plays critical role towards a good outcome of the patient following the surgery.

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