A BSTRACT The use of total intravenous anesthesia (TIVA) with target-controlled infusion (TCI), particularly using the Eleveld model, has gained increasing attention in neuroanesthesia due to its ability to provide stable hemodynamics and precise pharmacokinetic control during intracranial tumor surgery. Because their fundamental management pathways diverge significantly, establishing an accurate histopathological diagnosis through biopsy or limited surgical sampling is critical. Furthermore, effective neuroanesthetic management is vital to maintain cerebral oxygenation and prevent sudden spikes in intracranial pressure in patients with exhausted compensatory mechanisms due to mass effect. A 23-year-old female presented with worsening diffuse headaches, vomiting, and progressive cognitive decline. Neuroimaging revealed a heterogeneous solid intra-axial supratentorial mass crossing the corpus callosum with extensive surrounding vasogenic edema and a rightward midline shift, suspicious for primary central nervous system lymphoma. The patient underwent a craniotomy for tumor removal and diagnostic confirmation. General anesthesia was induced and maintained using TIVA with TCI of propofol utilizing the Eleveld model and remifentanil utilizing the Minto model. A regional scalp block using 0.25% bupivacaine was also administered to support analgesia. Continuous invasive arterial and central venous pressure monitoring were applied throughout the procedure. The surgery took 5–6 h; after the operation, the patient was transferred to the intensive care unit with a backup ventilator for postoperative care. TIVA using Eleveld and Minto TCI models provides precise, stable, and effective neuroanesthetic management in large intra-axial tumor surgery.
Thedja et al. (Thu,) studied this question.