PMC4508747_01
A, B: Pre- to post-operative volume changes of the medulla oblongata in patients with abnormal (A) and normal (B) hemodynamics. The closed (A) and open (B) squares with error bars (standard deviation) show the average volumes. C: Percentage increase in the preoperative volume in each group. *p = 0.026, **p = 0.002.
nmc-53-655-g3.jpg
PMC4508747_01_nmc-53-655-g3.jpg
F3
The preoperative volume of the tumor and MO were 17.4 cc and 3.08 cc, respectively (Table 2 and Fig. 3A; line with squares;  ). The postoperative volume of the MO was 4.99 cc, which represented an increase of 1.91 cc (62.0%) compared to the preoperative volume (Fig. 3A; line with squares;  ).
A-E: Preoperative (A: axial view, B: sagittal view) and postoperative (C: axial view, D: sagittal view) gadolinium-enhanced magnetic resonance imaging (MRI) and (E) anesthesia chart in an illustrative case. E: Bilateral-facing black arrows indicate a period of fluctuating blood pressure (BP) and heart rate (HR), and the black arrow indicates the points of maximal MAP and HR. ARTd: diastolic arterial pressure, ARTm: mean of arterial pressure, ARTs: systolic arterial pressure, NBPd: noninvasive diastolic blood pressure, NBPm: mean of noninvasive blood pressure, NBPs: noninvasive systolic blood pressure.
nmc-53-655-g4.jpg
PMC4508747_01_nmc-53-655-g4.jpg
F4
Gadolinium-enhanced MRI showed a heterogeneously enhanced, poorly circumscribed mass lesion with partial cyst formation located behind the brain stem (Fig. 4A, B). During manipulation of the dorsal side of the MO, BP and HR suddenly increased to 170/102 mmHg (MAP = 125 mmHg) and 149 bpm, respectively, without any apparent reason (Fig. 4E). Postoperative MRI indicated total tumor resection (approximately 98%) with transient mild right abducens nerve palsy and lower cranial nerve palsy neurologically (Fig. 4C, D).