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Anesthetic management of a parturient with multi-centric hemangiomas
Abstract Number: F-79
Abstract Type: Case Report/Case Series
Introduction: Vertebral hemangiomas are the most common benign vertebral neoplasms and most are asymptomatic. Pregnancy is a recognized risk factor for quiescent vertebral hemangiomas becoming symptomatic leading to radicular pain and even neurological compromise. There are several case reports of pregnancy-related vertebral hemagiomas leading to spastic paresis.1,2 Vertebral hemagiomas also present a complication from an anesthetic perspective with regard to analgesia during labor and choice of anesthetic for operative delivery.
Case: 32 year old nulliparous female presenting for a preanesthesia consultation for a history of muticentric hemagiomas involved her femurs, pelvic bones, and vertebrae. Initial diagnosis was made prior to pregnancy after presenting with significant pain in her left lower extremity and some pain in her lower back and gluteal region. The patient planned vaginal delivery and wished to discuss neuraxial labor analgesia options.
Lumbar spine MR images demonstrated significant involvement of the T12 and L2 vertebrae, extending past the vertebral bodies and involving the pedicles and lamina. The disease appeared primarily left-sided. Prior pathological reports indicated these lesions to be hemangiomas.
After careful literature review and multidisciplinary discussion, it was determined that the risks of neuraxial labor analgesia outweighed the benefits. There was concern that despite even correct localization with ultrasound, it would be very difficult to avoid contacting one of these lesions, which could result in a quickly expanding hematoma in the immediate proximity of the spinal cord. Therefore, the plan was made to utilize a Fentanyl PCA without basal rate for labor analgesia. Patient had an uncomplicated vaginal delivery and recovery.
Discussion: This case illustrates the potential complications that vertebral hemangiomas present for the anesthetic management of a parturient. Vertebral hemangiomas may lead to epidural hematoma or vascular steal with spinal cord ischemia and neurological compromise. There are increased risks associated with neuraxial technique in these patients that may outweigh any benefits.
1. Chi JH, et al. Pregnancy-related vertebral hemangioma. Case report, review of the literature, and management algorithm. Neurosurg Focus. 2005 Sep 15;19(3):E7.
2. Chestnut DH, et al. Chestnut's Obstetric Anesthesia: Principles and Practice. 5th ed. Philadelphia, PA: Mosby-Elsevier, 2014: Chapter 32.