Anaesthetic Management of a Patient with Dyke-Davidoff-Masson Syndrome Undergoing Robotic Thermocoagulative...

Dyke-Davidoff-Masson Syndrome (DDMS) is a rare neurological disorder characterized by cerebral hemiatrophy and compensatory calvarial changes, typically resulting from early-life cerebral insults. Patients may present with drug-resistant epilepsy (DRE), hemiparesis, and developmental delay. Due to its rarity and heterogeneous clinical presentation, diagnosis is often delayed or missed. We present the anaesthetic management of a 36-year-old male with DDMS undergoing Robotic Thermocoagulative Hemispherotomy (ROTCH) for DRE. The patient had a longstanding history of focal seizures since infancy and right-sided weakness. Radiological evaluation revealed left cerebral hemiatrophy, white matter volume loss, and compensatory hyperpneumatization of the frontal sinus. The procedure was performed under general anaesthesia with meticulous perioperative planning. Anaesthetic considerations included continuation of antiepileptic medications, potential alterations in drug metabolism due to hepatic enzyme induction, and careful airway management in view of craniofacial asymmetry. Robotic hemispherotomy was completed successfully without complications. The postoperative course was uneventful with a notable reduction in seizure frequency. This case underscores the importance of individualized anaesthetic strategies in patients with DDMS, highlighting the value of comprehensive preoperative assessment, attention to systemic anomalies, and intraoperative management in robotic neurosurgery. Additionally, it demonstrates the feasibility and efficacy of ROTCH as a minimally invasive surgical approach for refractory epilepsy in DDMS. Increased awareness and documentation of such rare cases are crucial for guiding clinical practice and optimizing outcomes in complex neuroanaesthetic scenarios. (Key words: DDMS, Epilepsy, Robotic Surgical Procedures, Seizures) Learning points: •Preparedness for a potentially difficult airway•Perioperative anti-seizure measures•Intraoperative anaesthetic goals in robotic neurosurgery.