The Complex Triad of Pregnancy, Neurosurgery, and Anesthesia: Insights from a Single-Center Case Series and Literature Review

Abstract

Neurosurgical intervention during pregnancy is rare but unavoidable in life-threatening conditions. Between January 2021 and January 2025, nine pregnant patients underwent neurosurgical procedures under general anesthesia at our tertiary care center. Indications included traumatic brain injury, intracranial tumors, subarachnoid hemorrhage, and sellar lesions. In five cases, surgery was combined with cesarean delivery. Despite the physiological complexities of pregnancy, all procedures were completed without intraoperative maternal complications. When pregnancy was continued, neonatal outcomes were favorable at discharge. In cases requiring termination followed by neurosurgery, one triplet pregnancy resulted in a single neonatal survivor, whereas in another case the child remained well, but the mother succumbed 4 months later due to disease recurrence. These cases suggest that neurosurgical procedures can be safely performed during pregnancy when supported by multidisciplinary coordination, careful anesthetic planning, and individualized decision-making.

Keywords

pregnancy - neurosurgical procedures - anesthesia - multidisciplinary communication - fetal monitoring - perioperative outcome

Introduction

Pregnancy introduces unique physiological changes that complicate surgical management, particularly when neurosurgical intervention becomes necessary. Though rare, such scenarios pose significant anesthetic and perioperative challenges, requiring meticulous coordination between obstetricians, neurosurgeons, neuroanesthesiologist, and critical care specialists.[1] Indication ranges from emergent conditions like traumatic brain injury or aneurysmal subarachnoid hemorrhage requiring decompressive craniectomy or endovascular coiling, to elective or semi-urgent interventions for intracranial tumors, sellar lesions, or spinal pathologies. Each situation demands careful balancing of maternal neurological priorities with fetal safety and gestational considerations.[1] [2] Given the lack of robust evidence and standardized guidelines, clinical decisions often rely on interdisciplinary judgment and institutional experience.

Case Description

We present a case series of nine pregnant patients who underwent neurosurgical procedures during pregnancy at our institute between January 2021 and January 2025. The study was conducted following approval from the institutional authority for retrieval of data (approval letter no. AIIMS/Rksh/Anaes/2025/212, dated March 17, 2025). Data were anonymized to protect patient confidentiality, and consent was obtained where appropriate in accordance with institutional policy. ([Table 1])

Intraoperative anesthetic management across all nine cases involved general anesthesia, with rapid-sequence induction performed in patients beyond the first trimester. Induction agents included propofol, fentanyl, and a muscle relaxant—either rocuronium, vecuronium, or succinylcholine depending on urgency and clinical context. Anesthesia was maintained with sevoflurane in an oxygen–air mixture, often supplemented with a propofol infusion (25–100 µg/kg/min) to optimize cerebral relaxation. Cerebral decongestants were tailored based on maternal and fetal considerations—hypertonic saline (3%) was used at doses of 3 to 4 mL/kg, whereas mannitol was avoided due to risk of fetal dehydration. Intravenous dexamethasone was administered in cases involving tumors or perilesional edema. It had an added benefit of fetal lung maturation as well. Ventilation strategies were tailored to individual cases: PaCO₂ was maintained at 30 to 35 mm Hg in stable cases to reflect normal pregnancy physiology, whereas in emergencies requiring intracranial pressure (ICP) control, controlled hyperventilation was used to target 25 to 30 mm Hg, avoiding values below 25 mm Hg due to the risk of uteroplacental vasoconstriction and fetal hypoxia. Fluid and blood product management varied with surgical complexity and blood loss, which ranged from 700 to 3500 mL. Balanced transfusion protocols were activated when blood loss exceeded 2,000 mL, with resuscitation using crystalloids, colloids, packed red blood cells (PRBCs), fresh-frozen plasma, and platelets. Five patients required blood transfusion intraoperatively, with up to 5 units of PRBC given in high-volume cases. Uterotonic use was carefully titrated: oxytocin was administered in reduced doses to minimize abrupt hemodynamic shifts and ergot derivatives were avoided due to their hypertensive and ICP-raising effects. Patient positioning was determined by gestational age: patients in the first or early second trimester were induced in the supine position with standard precautions, whereas those beyond 20 weeks were positioned with a left lateral tilt to minimize aortocaval compression. Notably, no intraoperative airway complications were encountered in our series.

Discussion

Neurosurgical interventions during pregnancy present complex challenges, requiring careful coordination between obstetric, anesthesia, and neurosurgical teams ([Fig. 1]). Across our case series, clinical decision-making was guided by maternal neurological status, gestational age, and the urgency of intervention. While general anesthesia was used in all cases, the specific anesthetic strategies varied according to pathology, urgency, and fetal considerations.

Fig. 1 A schematic overview highlighting key anesthetic challenges and neuropathological concerns in pregnant patients undergoing neurosurgery. This figure illustrates the multifactorial challenges encountered in anesthetic management of pregnant patients undergoing neurosurgery. It highlights physiological alterations of pregnancy, risks related to airway management, drug safety concerns, and positioning, alongside neurosurgical indications such as traumatic brain injury, tumors, and vascular lesions. The schematic underscores the need for individualized, multidisciplinary planning to ensure optimal maternal and fetal outcomes. CPP, cerebral perfusion pressure; HR, heart rate; HTS, hypertonic saline; SV, stroke volume.

Two patients (Cases 3 and 4) underwent emergency cesarean section followed by decompressive craniectomy due to raised ICP in late second and early third trimesters. This approach, although aggressive, enabled timely neurosurgical decompression while mitigating fetal risk. Similar approaches have been described in the literature, with favorable maternal outcomes reported when fetal maturity allows early delivery.[3]

In Cases 1 and 4, traumatic brain injury necessitated prompt surgical intervention. Hypertonic saline was used intraoperatively to reduce ICP, avoiding mannitol due to its potential for fetal dehydration.[2] [3] In line with current recommendations, we maintained PaCO₂ between 30 and 35 mm Hg to balance cerebral perfusion with uterine blood flow.[2] One patient (Case 1) developed status epilepticus postoperatively, highlighting the need for close neurocritical monitoring even after surgical decompression.

For intracranial neoplasms, surgical timing was determined by the degree of mass effect and symptom progression. In Case 2, a right frontal glioma was excised at 21 weeks of gestation due to worsening neurological symptoms. The decision to proceed in the second trimester was supported by both maternal benefit and completion of fetal organogenesis. This aligns with literature suggesting that the second trimester is optimal for elective neurosurgery. Corticosteroids were administered in multiple cases both for their antiedema effect and to promote fetal lung maturity when preterm delivery was anticipated.

Case 3, involving a triplet pregnancy and spontaneous subdural hematoma at 29 + 2 weeks, posed unique challenges. Following cesarean section, only one of the three neonate survived. High-volume transfusion was required intraoperatively due to significant blood loss, and the patient eventually required tracheostomy. This case underscores the heightened physiological burden in multifetal gestation and the difficulty in achieving favorable outcomes for all fetuses in emergent scenarios.

In the first and second trimesters, cerebrospinal fluid diversion procedures such as a ventriculoperitoneal shunt may be performed in the same manner as in nonpregnant patients. However, during the third trimester, alternatives like a ventriculoatrial shunt or third ventriculostomy are preferred to avoid potential uterine or visceral injury and to reduce the risk of triggering premature labor.[4] In Case 7, termination of pregnancy was performed first followed by shunt surgery since the patient was near term.

The role of intraoperative fetal monitoring in neurosurgery is debated. The American College of Obstetricians and Gynecologists recommends individualized decision-making with obstetric consultation, stressing the need for a multidisciplinary approach.[5] While fetal heart rate monitoring may detect impaired uteroplacental perfusion, its value is limited to settings where immediate obstetric intervention is feasible. Continuous monitoring requires additional personnel and clear plans for emergency delivery, which may not be practical during procedures such as craniotomy.[6] Some authors argue that fetal compromise is unlikely if maternal oxygenation and circulation are stable, while others advocate monitoring whenever possible. Case reports describe both successful management without monitoring and instances where unexpected fetal bradycardia necessitated urgent delivery. Overall, monitoring should be reserved for viable pregnancies where obstetric intervention is realistically possible, with maternal stabilization remaining the priority.[5] [6]

In our series, intraoperative fetal monitoring was not performed routinely but was individualized. Specifically, in Cases 6 and 8, ultrasound assessment of fetal heart rate was performed prior to anesthesia induction, immediately after induction, and subsequently on a “when necessary” basis intraoperatively. Additional assessments were performed at surgical completion, following anesthesia reversal, and in the postoperative period. This approach ensured fetal well-being at key perioperative milestones while recognizing the limited feasibility of continuous monitoring during neurosurgical procedures.

Regarding the safe use of antiepileptics: In our series, levetiracetam was administered for seizure prophylaxis in all patients, in line with institutional protocol. This parallels national and international trends, with Indian data showing increased use of levetiracetam as monotherapy and in polytherapy, and the MONEAD study identifying levetiracetam and lamotrigine as the most frequently prescribed regimens. Due to safety concerns, older agents such as valproate, phenobarbital, and phenytoin are now less commonly used in pregnancy, with newer drugs like lamotrigine and lacosamide preferred.[7] Levetiracetam is also considered safe during lactation, with low transfer into breast milk and minimal reported neonatal adverse effects, though data for older Anti-seizure medication (ASM)s remain limited.[8]

Obstetric and fetal complications during neurosurgical procedures are well recognized in the literature. Radiation exposure of 0.2 to 0.25 Gy between 2 and 8 weeks of gestation has been associated with growth restriction and congenital malformations, whereas doses as low as 0.01 to 0.02 Gy have been linked to an increased risk of childhood cancer.[9] Nevertheless, diagnostic imaging should not be delayed if clinically warranted. The American College of Radiology states that no single imaging study confers significant fetal risk, and radiation doses below 50 mGy are not associated with malformations or pregnancy loss. A routine computed tomography head delivers <0.01 mGy, which is well below the harmful threshold.[1] [10] [11] Whenever possible, uterine shielding should be applied. Although both iodinated and gadolinium-based contrast agents cross the placenta, their use is considered acceptable when clinically essential. Concerns have also been raised regarding exposure to anesthetic gases, with reports linking them to genotoxicity, early pregnancy loss, and low birth weight. However, these effects have not been demonstrated at concentrations used during general anesthesia, which is reassuring. The Occupational Safety and Health Administration sets exposure limits at a time-weighted average of 25 ppm for nitrous oxide during anesthetic administration, and 2 ppm averaged over 1 hour for halogenated agents.[9] With respect to the use of succinylcholine in patients with elevated ICP, it has been shown that this agent may cause a modest rise in ICP (∼5 mm Hg) when administered under light anesthesia. However, this effect—likely related to arousal or muscle fasciculations—can be effectively mitigated by ensuring an adequate depth of anesthesia, which prevents succinylcholine-induced ICP elevation.[10]

The primary goal in managing aneurysmal subarachnoid hemorrhage during pregnancy is to prevent rebleeding, which most often occurs during labor or in the early postpartum period. The general obstetric principle is to treat the aneurysm as if the patient were not pregnant—prioritizing aneurysm repair and allowing the pregnancy to continue. An important exception is during active labor, where the preferred approach is to deliver the fetus first, followed by definitive aneurysm treatment. Although coiling of aneurysms is considered safe, key concerns during pregnancy include fetal radiation exposure, contrast-induced anaphylaxis or nephropathy, and anesthetic challenges at remote locations.[11]

Brain tumors may enlarge during pregnancy due to elevated estrogen and progesterone levels. Surgical decisions depend on tumor size, location, maternal neurological status, fetal maturity, and patient consent. Whenever feasible, surgery should be deferred to the second trimester. Corticosteroids are beneficial for reducing cerebral edema and enhancing fetal lung maturity. Mannitol is avoided due to risk of fetal dehydration, whereas antiepileptics require cautious use due to teratogenicity.[12] [13]

Spine pathologies, although not represented in our series, merit consideration. Spine surgeries are best performed in the prone position during the first and early second trimester, when aortocaval compression is minimal.[14] After 12 weeks' gestation, a left lateral tilt is recommended. Intraoperative radiation exposure should be minimized, particularly during fluoroscopy, and a dosimeter may be used to monitor fetal dose.

With regard to anesthetic management, all patients received general anesthesia, induced with fentanyl, propofol, and a neuromuscular blocking agent. Rapid-sequence induction was performed in most cases beyond 15 weeks of gestation out of institutional protocol and perceived aspiration risk. Although the risk of aspiration in pregnant women beyond 15 to 18 weeks of gestation is relatively low, rapid sequence intubation continues to be routinely practiced in many centres. However, in selected patients—particularly those without obesity—recent studies support the safe use of supraglottic airway devices for elective and urgent cesarean deliveries.[15] [16]

With the introduction of the Pregnancy and Lactation Labeling Rule (PLLR) on June 30, 2015, the traditional Food and Drug Administration (FDA) pregnancy risk categories (A, B, C, D, X) have been phased out in favor of narrative sections that provide more detailed information on drug safety during pregnancy, lactation, and reproductive potential. Under this new system, pregnancy and labor are grouped into a single category, with an added section for females and males of reproductive potential. A limitation of this approach is that older medications and many over-the-counter products approved before June 30, 2001, may not have updated narrative summaries readily available to providers. In our series, agents such as propofol and sevoflurane—previously categorized as FDA Category B—were used safely in all patients. Despite the lack of PLLR narratives for some of these agents, both drugs are extensively used in obstetric and nonobstetric anesthesia without known teratogenicity.[17]

The criteria for deciding between surgical intervention and conservative management after traumatic brain injury (TBI) are the same in pregnant and nonpregnant patients. Even a single episode of hypotension is linked to significantly poorer outcomes compared with patients who remain normotensive.[4] According to the Brain Trauma Foundation (4th edition) guidelines, systolic blood pressure should be maintained at ≥100 mm Hg in patients aged 50 to 69 years, and at ≥110 mm Hg in those aged 15 to 49 years or over 70 years, as this may reduce mortality and improve outcomes. Cerebral perfusion pressure should be targeted between 60 and 70 mm Hg.[18]

Intraoperatively, strategies aimed at reducing ICP must be applied with caution. Severe hyperventilation (PaCO₂ ≈ 25 mm Hg) may cause uterine artery vasoconstriction and a leftward shift of the maternal oxyhemoglobin dissociation curve, potentially leading to fetal hypoxia and acidosis.[2] Hence, a target PaCO₂ of 25 to 30 mm Hg is recommended in emergent situations until definitive surgical intervention is achieved. Additionally, cautious use of uterotonics is warranted; reduced dosing of oxytocin analogues is advised to avoid excessive arterial vasodilation and further elevation in ICP. In cases of refractory uterine atony, agents such as carboprost or ergonovine may be considered. However, ergot alkaloids, which may indirectly increase ICP, should be avoided in patients with hypertensive disorders.[12]

For parturient undergoing neurosurgery, the postoperative course is not without complications. In our series, this was exemplified by Case 8, where the patient developed Diabetes Insipidus (DI) during first postoperative day and was managed with intake of clear fluids orally. During pregnancy, DI is usually managed with desmopressin (DDAVP), a synthetic analogue of arginine vasopressin that resists degradation by vasopressinase. Vasopressinase, secreted by placental trophoblasts beginning in the 7^th week of gestation, rises progressively with placental growth—up to a thousand-fold by term—peaking during the third trimester and returning to undetectable levels within 5 to 6 weeks' postpartum.[19] DDAVP can be administered intravenously or subcutaneously in initial doses of 2 to 5 µg, or given as tablets or nasal spray, which allow more precise titration. The total daily requirement, typically around 20 µg, is often divided into two doses, with a larger dose in the morning to replicate the normal diurnal variation in water balance. Caution is warranted in women with impaired renal function, such as those with preeclampsia, as clearance of DDAVP is reduced. Available evidence, although limited, suggests that DDAVP use in pregnancy is safe.[19] [20]

In summary, key considerations for anesthetic management of cases is summarized in [Table 2]. Overall, our experience supports existing evidence that neurosurgical intervention during pregnancy—when indicated—can be safely undertaken with multidisciplinary planning and tailored anesthetic strategies. Each case posed unique timing, physiological, and pharmacological considerations that required dynamic intraoperative adaptation and fetal assessment.

Table 1 Clinical profile and perioperative details of pregnant patients undergoing neurosurgical procedures

Case number	Age (y)/gravida/POG (wk)/GCS at presentation	Diagnosis/surgical intervention	Anesthesia induction Anesthesia maintenance	Postoperative course	Maternal/fetal outcome/hospitalization days
1	21/G5P3L3A1/13 wk/E2V1M4	Severe TBI with left temporal ICH with mass effect with splenic injury/left FTP decompressive craniectomy	Fentanyl → Propofol → Vecuronium O2 + air with sevoflurane + propofol infusion	Tracheostomy on POD 2, developed status epilepticus on POD 4	Good/in utero, stable at discharge/38 d
2	27/G2P1L1/21 wk/E3V2M5	Right frontal high-grade glioma/craniotomy and tumor excision	RSI → Fentanyl → Propofol →—-Rocuronium O2 + air with sevoflurane + propofol infusion	Extubated on POD 1, left facial palsy developed postoperatively	Good/in utero, stable at discharge/12 d
3	32/G1P0 with triplets (IVF)/29 + 2 wk/E1V1M2	Spontaneous right FTP acute SDH/emergency cesarean section followed by right FTP decompressive craniectomy	RSI → Propofol → Succinyl-choline → Fentanyl (after delivery) O2 + air with sevoflurane + propofol infusion	Tracheostomy on POD 4 Baby A – 970 g Baby B – 745 g Baby C – 940 g All 3 intubated, NICU admission	Discharged with focal deficits/only baby A survived/49 d
4	26/G2P1L0A1/31 + 4 wk/E1V1M5	Diffuse axonal injury with left FTP subdural hematoma with uncal herniation/emergency cesarean section followed by left FTP decompressive craniectomy	RSI → Propofol → Succinyl-choline → Fentanyl (after delivery) O2 + air with sevoflurane	Prolonged ICU stay Baby intubated (low Apgar score)	Discharged in M5 status/stable at discharge/33 d
5	32/G5P3L3A1/35 + 4 wk/E4V4M6-dull	Left anterior 1/3rd and middle 1/3rd parasagittal meningioma/Cesarean section followed by left temporo-parietal craniotomy and subtotal tumor resection	RSI→ Propofol → Succinylcholine → Fentanyl (after delivery) O2 + air with sevoflurane + propofol infusion	Developed focal seizures on POD 2	Mother and baby stable at discharge/7 d
6	35/G5P4L2A2/32 wk/E4V5M6	Left sinonasal moderately differentiated adenocarcinoma with intracranial and orbital extension/Cranio-facial resection with craniotomy with orbital exenteration	Modified RSI → Fentanyl → Propofol → Rocuronium O2 + air with TIVA (propofol with dexmedetomidine) intraoperative fetal monitoring done	Uneventful	Maternal mortality after 4 mo due to recurrence and lost to follow-up/born via C-section at term, low birth weight 2.3 kg/5 d
7	24/G1P0/34 + 5 wk/E3V4M6-dull	Right cerebellar hemangioblastoma with obstructive hydrocephalus/ Emergency cesarean section followed by external ventricular drain placement	RSI → Propofol → Rocuronium → Fentanyl (after delivery) O2 + air with sevoflurane	Tracheostomy on POD 2 in view of lower cranial nerve involvement	Stable at discharge/18 d
8	29/G3P1L1A1/25 wk/E4V5M6	Pituitary macroadenoma with pituitary apoplexy/trans-nasal trans-sphenoidal tumor excision	RSI → Fentanyl → Propofol → Succinylcholine O2 + air with sevoflurane intraoperative fetal monitoring done	developed diabetes insipidus on POD 1	Stable at discharge/in utero, stable at discharge/10 d
9	25/G1P0/32 wk/E3V4M5	Left temporal high grade glioma/left FTP craniotomy and excision	RSI → Fentanyl → Propofol → Succinylcholine O2 + air with sevoflurane + propofol infusion	Uneventful	Stable at discharge/in utero, stable at discharge/7 d

Abbreviations: A, abortion; E, eye opening; FTP, fronto-temporo-parietal; G, gravida; GCS, Glasgow Coma Scale; ICH, intracerebral hemorrhage; L, living; M, motor response; P, para; POD, postoperative day; POG, period of gestation; RSI, rapid sequence intubation; SDH, subdural hematoma; TBI, traumatic brain injury; TIVA, total intravenous anesthesia; V, Verbal response.

Table 2 Key learning points for neuroanesthesiologists in the management of pregnant patients undergoing neurosurgery

Key learning points for neuroanesthesiologists
Pregnancy is not a contraindication to lifesaving neurosurgery	Anesthetic decision-making should prioritize maternal neurological stability while safeguarding fetal viability, guided by gestational age and urgency
Multidisciplinary coordination is paramount	Seamless collaboration between neuroanesthesia, obstetrics, neurosurgery, and critical care determines success, particularly in high-stakes scenarios like simultaneous cesarean and craniotomy
Timing matters	When feasible, elective neurosurgical procedures should be scheduled in the second trimester after fetal organogenesis is complete, balancing maternal symptoms with fetal maturity
Anesthetic plan must anticipate dual physiology	Induction agents, positioning, ventilation strategies, and uterotonic use must be meticulously adapted to avoid maternal hypotension, increased ICP, or fetal compromise
Hyperventilation and osmotherapy must be used judiciously	Severe hypocapnia and mannitol use can endanger the fetus; hypertonic saline and controlled ventilation (PaCO2 25–30 mm Hg) are safer alternatives in the pregnant neurosurgical patient
Modern anesthetic agents are generally considered safe	Despite changes in FDA labeling, extensive clinical use supports the safety of propofol, sevoflurane, and dexmedetomidine in pregnancy, though drug-specific profiles and placental transfer must always be considered
High vigilance must extend beyond the OR	Postoperative complications like seizures, hemodynamic instability, or uterine atony must be anticipated in neurocritical care, where both neurological and obstetric expertise are critical

Abbreviations: FDA, Food and Drug Administration; ICP, intracranial pressure; OR, operating room

A key limitation of this study is that outcome reporting was restricted to available medical record data, without the use of validated scoring systems such as the Glasgow Outcome Scale or structured long-term obstetric and neonatal follow-up.

Conclusion

Neurosurgical procedures during pregnancy require a careful balance between maternal neurological needs and fetal safety. General anesthesia remains standard, with agent selection aimed at minimizing ICP changes and avoiding fetal harm. A multidisciplinary, individualized approach and judicious timing are key to optimizing maternal and neonatal outcomes.

This table highlights essential clinical takeaways derived from a single-center case series, focusing on anesthetic planning, intraoperative challenges, interdisciplinary coordination, and safe practice principles tailored to the dual considerations of maternal neurosurgical needs and fetal well-being.

Conflict of Interest

None declared.

• References

• 1 Ng J, Kitchen N. Neurosurgery and pregnancy. J Neurol Neurosurg Psychiatry 2008; 79 (07) 745-752
• 2 Wang LP, Paech MJ. Neuroanesthesia for the pregnant woman. Anesth Analg 2008; 107 (01) 193-200
• 3 Subha SS, Dhanapal M. Aiswary. A case series of craniotomy in obstetric patient: a lifesaving treatment modality. Int J Reprod Contracept Obstet Gynecol 2018; 7 (05) 2055-2060
• 4 Singh S, Sethi N. Neuroanesthesia and pregnancy: uncharted waters. Med J Armed Forces India 2019; 75 (02) 125-129
• 5 Fukuda K, Masuoka J, Takada S, Katsuragi S, Ikeda T, Iihara K. Utility of intraoperative fetal heart rate monitoring for cerebral arteriovenous malformation surgery during pregnancy. Neurol Med Chir (Tokyo) 2014; 54 (10) 819-823
• 6 Tuncali B, Aksun M, Katircioglu K, Akkol I, Savaci S. Intraoperative fetal heart rate monitoring during emergency neurosurgery in a parturient. J Anesth 2006; 20 (01) 40-43
• 7 Avachat C, Barry JM, Lyu X, Sherwin CM, Birnbaum AK. Management of anti-seizure medications during pregnancy: advancements in the past decade. Pharmaceutics 2022; 14 (12) 2733
• 8 Birnbaum AK, Meador KJ, Karanam A. et al; MONEAD Investigator Group. Antiepileptic drug exposure in infants of breastfeeding mothers with epilepsy. JAMA Neurol 2020; 77 (04) 441-450
• 9 Tomei KL, Hodges TR, Ragsdale E, Katz T, Greenfield M, Sweet JA. Best practices for the pregnant neurosurgical resident: balancing safety and education. J Neurosurg 2022; 138 (06) 1758-1765
• 10 Patel PM, Drummond JC, Lemkuil BP. Cerebral physiology and the effects of anesthetic drugs. In: Gropper MA. editor. Miller's Anesthesia. 10th ed.. Philadelphia: Elsevier; 2020: 208
• 11 Subramanian R, Sardar A, Mohanaselvi S, Khanna P, Baidya DK. Neurosurgery and pregnancy. J Neuroanaesth Crit Care 2014; 1: 166-172
• 12 Kotadia N, Kisilevsky AE. Anesthesia for the pregnant patient undergoing intracranial procedures. J Neurosurg Anesthesiol 2025; 37 (02) 150-155
• 13 Abd-Elsayed AA, Díaz-Gómez J, Barnett GH. et al. A case series discussing the anaesthetic management of pregnant patients with brain tumours. F1000 Res 2013; 2: 92
• 14 Choudhary D, Mohan V, Varsha AS, Hegde A, Menon G. Neurosurgical emergencies during pregnancy - management dilemmas. Surg Neurol Int 2023; 14: 151
• 15 Shin J. Anesthetic management of the pregnant patient: part 2. Anesth Prog 2021; 68 (02) 119-127
• 16 Brakke BD, Sviggum HP. Anaesthesia for non-obstetric surgery during pregnancy. BJA Educ 2023; 23 (03) 78-83
• 17 Pernia S, DeMaagd G. The new pregnancy and lactation labeling rule. P&T 2016; 41 (11) 713-715
• 18 Carney N, Totten AM, O'Reilly CS. et al. Guidelines for the management of severe traumatic brain injury, 4th edition. Neurosurgery 2017; 80 (01) 6-15
• 19 Hata S, Shinokawa N, Harada Y. et al. Cushing's syndrome with diabetes insipidus in pregnancy: a case report. BMC Endocr Disord 2025; 25 (01) 197
• 20 Hague WM. Diabetes insipidus in pregnancy. Obstet Med 2009; 2 (04) 138-141

Publication History

Article published online:
06 January 2026