[Anesthetic management of corpus callosotomy with electrophysiological monitoring: a case report].
We report anesthetic management of a 5-year-old girl for corpus callosotomy indicated for the treatment of intractable epilepsy. The procedure mandated intraoperative monitoring of evoked potentials and electrocorticogram. During the first half of the surgery until the corpus callosum was exposed, anesthesia was maintained with continuous infusion of propofol. Motor and somatosensory evoked potentials were monitored and diagnosed as intact throughout the procedure, with no epileptic activity observed in 32-lead electrocorticogram. Then propofol infusion was replaced with the inhalation of sevoflurane, 2.0% in air/oxygen mixture, which induced epileptic spike-and-wave activities, synchronized between the hemispheres, in electrocorticogram. After the completion of corpus callosotomy, we observed interhemispheric desynchronization of epileptic activities indicating successful surgical intervention. The patient emerged from anesthesia uneventfully with no neurological deficits, and thereafter with decreased incidence of generalized epileptic episodes. We suggest that such switch of anesthetic agents between propofol and sevoflurane should be helpful in intraoperative electrophysiological monitoring for ascertaining both functional preservation and successful intervention during epileptic surgery.
Fukamachi
Kikuyo
K
Department of Anesthesiology, Tokyo Women's Medical University, Tokyo 162-8666.
Kurata
Jiro
J
Ozaki
Makoto
M
D000758:Anesthesia / Q000379:methods*; D019162:Anesthetics, Combined; D002540:Cerebral Cortex; D002675:Child, Preschool; D003337:Corpus Callosum / Q000601:surgery*; D004594:Electrophysiology; D004827:Epilepsy / Q000601:surgery*; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008738:Methyl Ethers; D016343:Monitoring, Intraoperative / Q000379:methods*; D015742:Propofol; D000077149:Sevoflurane
D019162:Anesthetics, Combined; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol