Join now to get access to this content and more.
Become a SOAP member and have access to our benefits.
- 2020 SOAP Virtual Meeting Series Videos
- For Review: SOAP Consensus Statement on Neuraxial Procedures in Thrombocytopenic Parturients
- Sample Centers of Excellence Applications
- ASA Corner
- SOAP Policy and Procedure Manual (P&P Manual)
- SOAP Expert Opinions
- SOAP's Learning Modules
- 2019 Annual Meeting Lecture Videos
- December 2018 - SOAP Unofficial Guide to ASA Committees Webinar
- Submit a Position
- View Job Postings
- Previous Meeting Archives
- Previous Meeting Abstract Search
- CMS Guidelines
- Member Benefits
- Newsletter Clinical Articles
- ACOG Documents
- Search our Patient Safety Archive
- Ask SOAP a Question
- Global Health Opportunities
- And more…
Management of a Parturient with Neurofibromatosis Type 1
Abstract Number: T-56
Abstract Type: Case Report/Case Series
Neurofibromatosis Type 1 (NF-1), an autosomal dominant disorder with multiorgan system manifestations, can have significant implications for both general and neuraxial anesthesia. We present a case of a 35 year-old G1P0 with NF-1 and multiple asymptomatic cervical and lumbar lesions; in addition, she was anti-coagulated for Factor V Leiden heterozygosity and a unilateral internal carotid stenosis. She had an asymptomatic C2-3/3-4 mass at the neural foramina extending into the spinal canal and bilateral lumbo-sacral neurofibromas. She otherwise had diffuse stable lower extremity neuropathy. Specific anesthetic concerns included possible progression of her lumbar nerve root lesions and anticoagulation precluding placement of a neuraxial block, particularly the “blind” threading of an epidural catheter, and the vulnerability of her cervical spine during head manipulation during general anesthesia.
A multidisciplinary team of neuro-oncologists, OB Anesthesiologists and obstetricians discussed plans for anticipated vaginal delivery but ultimately, we felt that repeat imaging was necessary to guide the anesthetic plan. She underwent an MRI which showed a stable cervical spine lesion and a new finding of an epidural hematoma at L3-4, presumed to be the result of a bleeding neurofibroma. As there was no apparent cord compression or new neurologic symptoms, her LMWH was stopped and she was observed. She subsequently delivered a healthy newborn baby girl via vacuum-assisted vaginal delivery (indication: fetal bradycardia). She was not considered to be a candidate for a spinal or epidural and therefore received Fentanyl PCA.
This case highlights obstetric anesthetic implications of neurofibromatosis and the benefits of antepartum obstetric anesthesia consultation.
Hirsch NP, Murphy A, Radcliffe JJ. Neurofibromatosis: clinical presentations and anaesthetic implications. BJA. 2001; 86(4): 555-64.
Dounas M., Mercier FJ, Lhuissier C, Benhamou D. Epidural analgesia for labour in a parturient with neurofibromatosis. Can J Anaesth. 1995; 42: 420-4
Dugoff L, Sujansky E. Neurofibromatosis type 1 and pregnancy. Am J Med Genet. 1996; 66(1): 7-10.
Esler MD, Durbridge J, Kirby S. Epidural haematoma after dural puncture in a parturient with neurofibromatosis. BJA. 2001; 87(6): 932-4