///2015 Abstract Details
2015 Abstract Details2019-08-02T16:54:43-06:00

Anesthetic Management of a Parturient with Intracranial Sellar Mass

Abstract Number: S-07
Abstract Type: Case Report/Case Series

Lester Chua MD1 ; Lester Chua MD2; Chinwe Ihenatu MBBCh3; Shobana Bharadwaj MBBS4; Andrew Malinow MD5

INTRODUCTION: We describe a woman who in the late third trimester developed rapidly progressing neurologic signs and symptoms. Admitted to the hospital, she underwent extensive medical evaluation leading to a multi-disciplinary delivery plan in this patient diagnosed with a sellar mass.

CASE REPORT: At 37 weeks EGA, a 25 year-old G4 P3003 (2 prior cesarean deliveries) presented to Labor and Delivery with a chief complaint of recurrent headaches and dizziness, recently complicated by unsteady gait and frequent falls and an episode of loss of consciousness. Already diagnosed with Class A2 diabetes (oral therapy), her past medical history was significant for hypothyroidism (on synthroid) and resolved hypertension. Three days before admission, analysis of Holter monitor recording (ordered for previous complaints of dizziness) did not reveal any abnormality. Non-contrast MRI revealed a 1.1 x 2 X 1.7 cm sellar mass abutting the optic chiasm. Prolactin level was 668 ng/ml. She was started on bromocriptine. Eventually, physicians from the neurology and neurosurgery, cardiology, ophthalmology and obstetric anesthesiology services were consulted, giving input into her delivery plan. At 38 1/7 weeks, the patient developed worsening visual changes(bitemporal hemianopsia) prompting an urgent repeat cesarean delivery. According to our plan, and without evidence of intracranial mass effect, combined spinal-epidural anesthesia was routinely induced via 27g Whitacre/17g Weiss needles. The patient and neonate tolerated the anesthetic and delivery without issue and were discharged on POD #4. The patient was rescheduled for a repeat prolactin levels and brain MRI for assessment prior to surgical resection. At last report, the patient has not responded to repeated attempts to contact her. She is now considered lost to follow-up.

DISCUSSION: The anesthetic considerations in parturients with intracranial mass include:

1)Delivery vs. combined delivery/neurosurgical procedures

2)Intracranial pressure (ICP)

a.Intracranial mass vs. mass effect

b.ICP changes during pregnancy

c.ICP changes in labor and vaginal delivery

d.Monitoring ICP

e.Neuraxial blockade – changes in ICP

f.General anesthesia

i) induction (RSI vs modified RSI: timing; paralytics)

ii) antihypertensive agents

iii) volatile vs iv maintenance

iv) emergence and extubation

3)Postpartum follow-up

References:

1. Leffert LR., et al: Neuraxial Anesthesia in Parturients with Intracranial Pathology: Anesthesiology 2013; 11:219-21

2. Finfer SR: Management of labour and delivery in patients with intracranial neoplasms. Br J Anaesth 1991; 67:784–7

3. Motlich MR., et al: Prolactinoma in Pregnancy: Endo & Metabolism 2011; 885-896

SOAP 2015