Dexamethasone-Adjuvanted Scalp Block and Total Intravenous Anesthesia for Endoscopic Transsphenoidal Resection of a Giant Sellar-Suprasellar Rathke Cleft Cyst: An Observational Analytic Case Study

Abstract

Background. Endoscopic transsphenoidal surgery for sellar-suprasellar lesions needs stable hemodynamics and a dry field. Case descriptions of a dexamethasone-adjuvanted scalp block with total intravenous anesthesia are scarce.

Objective. To describe the anesthetic management and the postoperative sodium and urine course of one patient and to discuss what the case suggests.

Methods. Single-patient case report (CARE guideline). A 45-year-old woman with hypertension had bitemporal visual field loss from a giant sellar-suprasellar Rathke cleft cyst. After induction, an ultrasound-guided bilateral scalp block used 20 mL of 0.375% ropivacaine with 10 mg of preservative-free dexamethasone. Propofol (bispectral index 40–60), fentanyl, and atracurium infusions maintained anesthesia during a 5-hour endoscopic resection, with a mean arterial pressure (MAP) target of 65–80 mmHg.

Results. MAP fell from 122 mmHg at baseline to 76–82 mmHg from induction to the end of resection and was 84 mmHg at emergence, without vasoactive rescue. Estimated blood loss was 60 mL, and the field was reported dry. Extubation was cough-free. Urine output was 2.35 mL/kg/h over the first 14 postoperative hours, and sodium fell to 132 mEq/L on day 1, 9.0% below the first pre-operative value of 145 mEq/L. This was managed with fluid restriction without desmopressin. By 48 hours urine output was 1.1–1.4 mL/kg/h and sodium 138 mEq/L. She went home on day 5 without complication.

Conclusion. Stable hemodynamics, low blood loss, and smooth emergence followed this combined technique, and early diuresis with mild hyponatremia settled with fluid restriction. One case cannot show efficacy, and controlled studies are needed.