Supratentorial Tumors

Surgical resection of supratentorial brain tumors presents a unique set of challenges to the anesthesiologist. While symptoms from these lesions vary in presentation, increased intracranial pressure (ICP) is frequently part of the constellation and an important piece of anesthetic management. Along with maintenance of ICP, the goals of induction, maintenance, and emergence from these resections are to maintain cerebral blood flow (CBF) and cerebral metabolic rate and optimize neuroprotection. There is no single technique that is agreed upon in literature to encompass these goals, however a combination of IV anesthetics with low-dose volatile agents (0.5 MAC) is common in practice. Management of ICP is the hallmark of these cases since increased ICP may lead to ischemia, poor surgical visualization, and catastrophic herniation.