Acute macroglossia post craniotomy in sitting position: A case report and proposed management guideline

Abstract

Background: Macroglossia is a rare life-threatening postoperative complication in patients undergoing neurosurgical operations in a sitting position. It is difficult to identify the cause of macroglossia, which can be considered multifactorial in most patients. Case Presentation: We herein present a case of a 37-year-old female patient who was known to have a posterior occipital lesion (low-grade glioma with pilocytic features) and underwent occipital craniectomy followed by supratentorial approach for debulk-ing of the tumor under general anesthesia in a sitting position. The patient developed upper airway edema along with extreme macroglossia immediately following extuba-tion, with increasing difficulty in ventilation. Re-intubation was impossible, and urgent tracheostomy was performed. In the intensive care unit (ICU), the macroglossia worsened, and the patient developed sepsis with multi-organ failure and died 16 days postoperatively. Conclusion: Acute macroglossia can be a catastrophic postoperative complication, necessi-tating early identification and a systematic approach to this critical event, in addition to being fully prepared to deal with difficult airway should this complication occur.