///2017 Abstract Details
2017 Abstract Details2019-08-02T15:54:53-06:00

Case Report: Meningioma with Symptomatic Mass Effect Requiring Urgent Cesarean Delivery

Abstract Number: F-72
Abstract Type: Case Report/Case Series

Jennifer E Lee MD, MPH1 ; Jennifer E Lee MD, MPH2; Cathleen Peterson-Layne MD, PhD3

Case Report: Meningioma with Symptomatic Mass Effect Requiring Urgent Cesarean Delivery

A 28 year old primigravida at 35 weeks was admitted for scheduled primary cesarean for symptomatic petroclival meningioma. Written permission was obtained for this report.

Antepartum course was uneventful until 20 weeks gestation when she developed trouble swallowing followed by right-sided facial weakness. MRI revealed large right-sided petroclival mass with midline shift. At 33 weeks gestation worsening symptoms included right facial droop and sixth nerve palsy, reduced gag reflex, hearing loss, and daily headaches concerning for elevated ICP. Neurosurgeon prescribed steroids. Although symptoms did not improve, neurosurgeon recommended delivery at 35 weeks. Due to concerns for elevated ICP, multidisciplinary team including obstetric anesthesiologist recommended delivery by scheduled cesarean to avoid ICP increase with vaginal delivery, plus passive second stage would require neuraxial technique.

On day of surgery, routine preoperative fetal heart rate monitor revealed prolonged decel prompting emergent delivery.

Fetal status was reassessed in the OR. Decision was made to place arterial line followed by rapid sequence induction with remifentanil, propofol and rocuronium; intubation with video laryngoscope. Anesthesia was maintained with isoflurane and remifentanil infusion. Hemodynamics stable throughout. Patient was extubated in the OR, then recovered uneventfully in PACU. Neurological exam remained unchanged. She was discharged home on POD 3. Apgar scores were 4 and 8, at 1 and 5 minutes. Neonate was intubated for RDS and admitted to NICU for 3 days and discharged home at day of life 7.

At 4 weeks postpartum, she underwent transpetrosal transsigmoidal meningioma resection. Procedure was noted to be challenging, with tumor crossing midline and evidence of hydrocephalus. The tumor engulfed cranial nerves and blood vessels, with substantial, yet subtotal resection.

At 4 months postop, she had improved facial symmetry, yet persistent hearing loss and mild facial weakness. She is currently undergoing radiation therapy.

Discussion: Not all intracranial lesions lead to increased ICP.1 Assessment of intracranial compliance is critical in assessing the safety of regional techniques in parturients with space occupying lesions. Regional technique in the setting of increased ICP has serious potential complications as rapid changes in spinal pressure from a dural puncture can cause brain herniation, intracranial hemorrhage, and subdural hemorrhage.2 General anesthesia can be safely performed with particular focus on minimizing elevations in ICP.

1. Leffert LR, Schwamm LH. Neuraxial Anesthesia in Parturients with Intracranial Pathology: A Comprehensive Review and Reassessment of Risk. Anesthesiology. 2013;119(3):703-718.

2. El-Refai NAE-R. Anesthetic management for parturients with neurological disorders. Anesthesia, Essays and Researches. 2013;7(2):147-154.

SOAP 2017