Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
Department of Medicine, Box Hill Hospital, Box Hill, Victoria, Australia.
BMJ Case Rep. 2021 May 12;14(5):e240575. doi: 10.1136/bcr-2020-240575.
A nulliparous patient in her early 20s was referred to a fertility specialist for fertility preservation, before commencing chemo-radiation therapy for a recently diagnosed malignant brain tumour. Two weeks prior, she had presented with seizures and undergone emergency craniotomy and tumour resection. Taking into consideration of the tight time frame and her comorbidities, several measures were undertaken to minimise the potential increase in intracranial pressure that may lead to cerebral oedema during laparoscopy. Preoperatively, the anaesthetist administered 8 mg dexamethasone as prophylaxis. Intraoperatively, the degree of head-down tilt was minimised to 10, which was just adequate to displace bowel cranially for visualisation of pelvic structures. Finally, a shorter operative time was achieved by ensuring the most senior surgeon performed the operation, and the procedure itself was altered from the standard approach of ovarian harvesting to unilateral oophorectomy. The patient made a quick recovery and was discharged home day 1 postoperatively.
一位 20 多岁的初产妇因近期诊断出的恶性脑肿瘤，在开始化疗和放疗前，被转介给一位生育专家进行生育力保存。两周前，她因癫痫发作接受了紧急开颅手术和肿瘤切除。考虑到时间紧迫和合并症，采取了几种措施来尽量减少可能导致腹腔镜检查期间脑水肿的颅内压升高。术前，麻醉师给予 8mg 地塞米松预防。术中，头低位倾斜度最小化至 10 度，足以将肠腔推向颅侧以观察盆腔结构。最后，通过确保最资深的外科医生进行手术，并将手术本身从标准的卵巢采集方法改为单侧卵巢切除术，以缩短手术时间。患者恢复迅速，术后第 1 天出院回家。
