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Laparoscopic gynaecological surgery in the context of maintaining normal intracranial pressure
  1. Joyce Shuang Xiao1,2,
  2. Kenneth Leong3,
  3. Alan Meads3 and
  4. Pav Nanayakkara3
  1. 1Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
  2. 2Department of Medicine, Box Hill Hospital, Box Hill, Victoria, Australia
  3. 3Epworth Hospital, Richmond, Victoria, Australia
  1. Correspondence to Dr Joyce Shuang Xiao; joyce.xiao93{at}


A nulliparous patient in her early 20s was referred to a fertility specialist for fertility preservation, before commencing chemo–radiation therapy for a recently diagnosed malignant brain tumour. Two weeks prior, she had presented with seizures and undergone emergency craniotomy and tumour resection. Taking into consideration of the tight time frame and her comorbidities, several measures were undertaken to minimise the potential increase in intracranial pressure that may lead to cerebral oedema during laparoscopy. Preoperatively, the anaesthetist administered 8 mg dexamethasone as prophylaxis. Intraoperatively, the degree of head-down tilt was minimised to 10, which was just adequate to displace bowel cranially for visualisation of pelvic structures. Finally, a shorter operative time was achieved by ensuring the most senior surgeon performed the operation, and the procedure itself was altered from the standard approach of ovarian harvesting to unilateral oophorectomy. The patient made a quick recovery and was discharged home day 1 postoperatively.

  • reproductive medicine
  • anaesthesia
  • surgery

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  • Contributors All authors contributed to the writing of the manuscript. JSX and PN initiated the case report and wrote the manuscript. JSX performed the literature search. AM and KL revised the manuscript. All authors have approved the manuscript and agree with its submission to BMJ Case Reports.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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