PIG Meeting: 29th April 2021

57-year-old man with metastatic intraductal parotid cancer for Prophylactic THR

Background

• WLE + parotidectomy + temporal bone/mastoid tip resection/neck dissection
• Adjuvant concurrent chemo/radiotherapy
• Multiple post-operative and post-radiotherapy lesions including facial drop and poor mouth opening.
• current smoker

Issues

• New cerebellar and temporal lobe lesions
• No neurological symptoms
• Awaiting neurosurgical review, unlikely to occur pre operatively
• Multiple bony lytic lesions including acetabulum and ischial tuberosity
• Uncertain if having acetabular component to surgery
• Potential difficult airway

Discussion

1. Anaesthetic plan

• GA vs Spinal discussed
• Concern expressed regarding spinal placement with large and expanding cerebellar lesions
• Radiotherapy to face and jaw, airway may be challenging
• Surgery sounds like it could be complex and lengthy, likely in lateral position
• GA and secure airway would be preferred plan

2. Neurosurgical review

• Asymptomatic
• Large lesions, increased in size between scans
• Consensus Neurosurgical team should review scans and/or patient preoperatively

Plan

• Neurosurgical review preoperatively – has occurred – aim to proceed to THR for tissue diagnosis of metastatic disease.
• Clarify with surgeon regarding surgical procedure
• Plan for GA and potential difficult airway