///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Neuraxial anesthesia in a parturient with Idiopathic Intracranial Hypertension and a Lumboperitoneal shunt

Abstract Number: FCD-378
Abstract Type: Case Report Case Series

Heather D Craig MD1 ; Yaakov Beilin MD2; Jeffrey Zahn MD3

Introduction:

Idiopathic Intracranial Hypertension (IIH), or Pseudotumor Cerebri, is characterized by increased intracranial pressure of unknown etiology with no evidence of hydrocephalus or mass lesion. Symptoms include headache, papilledema, and transient vision loss. Lumboperitoneal (LP) shunts may be used to treat IIH in patients who are unresponsive to conservative management or those with rapidly progressive symptoms. There is controversy regarding the safety of neuraxial anesthesia in these patients. We present a case of neuraxial anesthesia for labor analgesia in a patient with IIH and an LP shunt.

Case Report:

A 30-yr-old G1P0 was admitted at 39 weeks and 2 days gestation in labor. Her history included IIH successfully treated 6 years before with placement of a LP shunt at the T11-T12 interspace. She was currently asymptomatic and denied any recent headaches or visual changes. On exam she had a vertical midline scar over her lumbar spine at approximately L1-L3 with a tunneled shunt palpated in the soft tissue to the right of her spine. A pre-pregnancy CT revealed the shunt exiting the epidural space at L1-L2 and tunneled to the right into the peritoneal cavity (Figure). A combined spinal-epidural was placed at the L3-L4 level which was well below the LP shunt. Her labor progressed uneventfully, and she delivered a healthy neonate nine hours later. Two hours after her delivery the epidural catheter was removed without complication.

Discussion:

There are conflicting recommendations regarding the safety of neuraxial anesthesia in someone with an LP shunt. Concerns include potential damage to the LP shunt by the epidural or spinal needle, entanglement of the epidural catheter with the shunt, infection, and unpredictable block spread and duration due to local anesthetic wash-out into the peritoneal cavity through the shunt. After review of the CT, we were comfortable placing the epidural catheter below L1-L2, which was the exact location of the shunt. This case highlights that with proper imaging one can identify the location of the shunt and assure that the epidural catheter will not interfere with the shunt.

References:

Karmaniolou I, Petropoulos G, Theodoraki K. Management of idiopathic intracranial hypertension in parturients: anesthetic considerations. Can J Anesth 2011;58:650-7.

Bedard JM, Richardson MG, Wissler RN. Epidural anesthesia in a parturient with a lumboperitoneal shunt. Anesthesiology 1999; 90: 621-3.



SOAP 2019