Successful Management of arachnoid cyst and syringomyelia using thoracic epidural anesthesia and general anesthesia: A case report

Anesthetic management in neurosurgical procedures involving the spinal cord must be accomplished with great caution so that there will be better patient safety and outcomes. The anesthetic management of a 55-year-old female patient diagnosed with an arachnoid cyst and syringomyelia is described in this case report. She presented to the emergency room with a complaint of backache. The lower back pain was so severe that she was not able to walk properly. She was diagnosed as having a non-enhancing extradural cystic lesion based on an MRI and was referred for surgical intervention. General anesthesia, along with thoracic epidural anesthesia, was employed to ensure optimal pain control along with minimized systemic opioid usage. A thoracic epidural was placed at the T5-T6 interspace, and a continuous infusion of 0.1% bupivacaine mixed with fentanyl was started. Following this, general anesthesia was administered. The surgical procedure was laminectomy between D5 and D8 for the excision of the cyst with decompression of the spinal cord. The thoracic epidural was kept in place for 48 hours postoperative to ensure good analgesia. The patient was subsequently discharged. This case demonstrates the value of a double anesthetic technique in the management of neurosurgical patients. It helps drive home and reemphasize the need for tailored techniques in enhancing postoperative outcomes.