Skip to main content Accessibility help
  • Print publication year: 2011
  • Online publication date: May 2011

Case 70 - Permissivehypertension in a patient with von Willebrand's disease and a preexisting ventriculoperitoneal shunt

from Section I - Neuroanesthesia


Pediatric surgical patients present special anesthetic challenges including induction without intravenous (IV) access, a higher incidence of airway complications, and a greater incidence of hemodynamic instability due to surgical blood loss. Supratentorial tumors are the second most common location and include low-grade astrocytoma, malignant and mixed glioma, ependymoma, ganglioglioma, oligodendroglioma, choroid plexus tumor, and meningioma. This chapter presents a case study of a 8-year-old child presented with partial complex seizures characterized by staring spells accompanied by oral and manual automatisms. Preoperative evaluation (magnetic resonance imaging) demonstrated a non-enhancing heterogeneous lesion in the mesial aspect of the right temporal lobe consistent with lowgrade glial neoplasm. A neurologic assessment was performed after extubation and it showed no neurologic deficits. Subsequently the patient was transported to the pediatric intensive care unit where his recovery was satisfactory. Anticonvulsant medications should be continued and administered the day of surgery to prevent intraoperative and postoperative seizures.


1. S. V. Jackman, J. D. Weingart, S. G. Docimo. Laparoscopic surgery in patients with ventriculoperitoneal shunts: safety and monitoring. J Urol 2000; 164: 1352–4.
2. R. G. Uzzo, M. Bilsky, D. T. Minimberg et al. Laparoscopic surgery in children with ventriculoperitoneal shunts: effect of pneumoperitoneum on intracranial pressure – preliminary experience. Urology 1997; 49: 753–7.
3. A. F. Kalmar, J. Van Aken, J. Caemaert et al. Value of Cushing reflex as warning sign for brain ischaemia during neuroendoscopy. Br J Anaesth 2005; 94: 791–9.
4. W. S. Almaani, A. S. Awidi. Spontaneous intracranial hemorrhage secondary to von Willebrand's disease. Surg Neurol 1986; 26: 457–60.
5. R. Nakau, M. Nomura, S. Kida et al. Subarachnoid hemorrhage associated with von Willebrand's disease – case report. N Neurol Med Chir 2005; 45: 631–4.
6. J. Ravaoherisoa, P. Meyer, R. Afriat et al. Laparoscopic surgery in a patient with ventriculoperitoneal shunt: monitoring of shunt function with transcranial Doppler. Br J Anaesth 2004; 92: 434–7.
7. J. J. Baskin, A. G. Vishteh, D. E. Wesche et al. Ventriculoperitoneal shunt failure as a complication of laparoscopic surgery. JSLS 1998; 2: 177–80.
8. J. A. Brown, M. D. Medlock, D. M. Dahl. Ventriculoperitoneal shunt externalization during laparoscopic prostatectomy. Urology 2004; 63: 1183–5.