Anaesthetic management for combined emergency caesarean section and craniotomy tumour removal

Abstract

Presentation of primary intracranial tumour during pregnancy is extremely rare. Symptoms of brain tumour include nausea, vomiting, headache and seizures which mimic symptoms of pregnancy-related hyperemesis or eclampsia. In very few cases, craniotomy tumour removal is performed earlier or even simultaneously with foetal delivery. A 40-year-old woman at 32 weeks of gestation in foetal distress presented to the emergency room with decreased level of consciousness Glasgow Coma Scale 6 (E2M2V2). Computed tomographic scan revealed a mass lesion over the left temporoparietal region with midline shift and intratumoural bleeding. In view of high risk of herniation and foetal distress, she underwent emergency caesarean section followed by craniotomy tumour removal. In parturient with brain tumour, combined surgery of tumour removal and caesarean section is decided based on clinical symptoms, type of tumour and foetal viability. Successful anaesthetic management requires a comprehensive knowledge of physiology and pharmacology, individually tailored to control intracranial pressure while ensuring the safety of mother and foetus.

Keywords

Caesarean section - craniotomy - intracranial tumour - pregnancy

• REFERENCES

• 1 Hool A. Anesthesia in pregnancy for non-obstetric surgery. Anaesthesia Tutorial of the Week 185. 2010 p. 1-9
• 2 Fast A, Shapiro D, Ducommun EJ, Friedmann LW, Bouklas T, Floman Y. Low-back pain in pregnancy. Spine (Phila Pa 1976) 1987; 12: 368-71
• 3 Ng J, Kitchen N. Neurosurgery and pregnancy. J Neurol Neurosurg Psychiatry 2008; 79: 745-52
• 4 Khurana T, Taneja B, Saxena KN. Anesthetic management of a parturient with glioma brain for cesarean section immediately followed by craniotomy. J Anaesthesiol Clin Pharmacol 2014; 30: 397-9
• 5 Reitman E. Flood P Anaesthetic considerations for non-obstetric surgery during pregnancy. Br J Anaesth 2011; 107 Suppl (Suppl. 01) i72-8
• 6 Morgan Jr. GE, Mikhail MS, Murray MJ. Clinical Anesthesiology. 4th ed.. New York: McGraw-Hill Companies; 2006. p. 216-7
• 7 Wang LP, Paech MJ. Neuroanesthesia for the pregnant woman. Anesth Analg 2008; 107: 193-200
• 8 Sahu S, Lata I, Gupta D. Management of pregnant female with meningioma for craniotomy. J Neurosci Rural Pract 2010; 1: 35-7
• 9 Chung JH, Rho JH, Jung TH, Cha SC, Jung HK, Lee C. et al. Anesthetic management of a parturient for combined cesarean section and surgical removal of pituitary tumor – A case report-. Korean J Anesthesiol 2012; 62: 579-83
• 10 Van De Velde M, De Buck F. Anesthesia for non-obstetric surgery in the pregnant patient. Minerva Anestesiol 2007; 73: 235-40
• 11 Qaiser R, Black P. Neurosurgery in pregnancy. Semin Neurol 2007; 27: 476-81
• 12 Kuczkowski KM. The safety of anaesthetics in pregnant women. Expert Opin Drug Saf 2006; 5: 251-64
• 13 Wlody DJ, Weems L. Anesthesia for neurosurgery in the pregnant patient. In: Cotttrell and Young's Neuroanesthesia. 5th ed.. Ch. 23. Philadelphia: Elsevier; 2010. p. 416-24