Supratentorial Craniotomy, Raised Intracranial Pressure, and Brain Relaxation Techniques — WACS Viva & Clinical Scenarios (Neuroanaesthesia)

Exam-style supratentorial craniotomy, raised intracranial pressure, and brain relaxation techniques viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 52-year-old woman presents with a 3-month history of progressive morning headaches, projectile vomiting, and left hemiparesis. Cranial CT reveals a 6 cm right frontoparietal mass with 12 mm midline shift and severe perilesional vasogenic oedema. She is scheduled for an elective craniotomy. Outline your complete anaesthetic management from preoperative optimization to emergence.
• SCENARIO 2: A 46-year-old male with a left sphenoid wing meningioma is undergoing craniotomy under balanced general anaesthesia. Upon dural opening, the neurosurgeon reports an extremely tight, bulging brain and requests your immediate intervention to achieve brain relaxation. Detail your systematic, stepwise management of this intraoperative crisis.
• SCENARIO 3: A 60-year-old known hypertensive male on amlodipine presents with sudden loss of consciousness, GCS of 9 (E2V2M5), blood pressure 205/115 mmHg, heart rate 54 bpm, and an acute right-sided lobar haematoma on non-contrast CT. He is booked for emergency craniotomy. Formulate your induction and hemodynamic control strategy.
• SCENARIO 4: A 38-year-old female is undergoing a left frontal glioma excision near Broca's area. The neurosurgeon requests a very smooth extubation at the end of surgery to assess motor speech function immediately without coughing or hypertension. Detail your emergence technique and pharmacological choices to achieve this goal.