TCI of Propofol Combined with Multimodal Analgesia for Neurophysiological Intraoperative Monitoring during Craniotomy for Meckel's Cave Meningioma Resection

Abstract

Introduction: Meckel’s cave meningioma is an intracranial tumor located in close proximity to critical neurovascular structures. An effective anesthetic strategy is essential to optimize outcomes and minimize complications.
Case: A 38-year-old woman with progressive ptosis, diplopia, and proptosis was diagnosed with Meckel’s cave meningioma. She underwent craniotomy with intraoperative neurophysiological monitoring (IOM) under general anesthesia managed with Target-Controlled Infusion (TCI) of propofol and dexmedetomidine. TCI of propofol, with Schnider mode was adjusted to a target effect concentration of 2-6 μg/mL. Dexmedetomidine was administered at a dose of 0.3-0.7 mcg/kg/hour. A multimodal analgesic approach, including scalp block with ropivacaine and dexamethasone was performed to reduce opioid consumption and manage pain. The procedure was completed without complications. Postoperatively, the patient demonstrated stable hemodynamics, no new neurologic deficits, and effective pain control.
Discussion: Anesthesia protocol, including propofol TCI and dexmedetomidine, was performed to maintain signal integrity, allowing safe tumor resection while minimizing the risk of postoperative deficits. The combination of propofol TCI, dexmedetomidine, and multimodal analgesia was shown to achieve stable hemodynamic and neurophysiological conditions during craniotomy for Meckel’s cave meningioma.
Conclusion: The combination of propofol TCI, dexmedetomidine, and multimodal analgesia is effective in maintaining stable hemodynamic and neurophysiological conditions during craniotomy for Meckel’s cave meningioma.