Anaesthetic management in neurological disorders: is combined spinal-epidural a suitable option?
Tuberous sclerosis (TSC) is a rare disease with multi-systemic affectation, predominantly neurological. Little evidence exists about the anaesthetic management of patients with this disorder, particularly in pregnant women. We present the case report of a patient with TSC admitted in our hospital for the delivery of a twin gestation. Twenty-four hours after surgery, the patient presented left-sided facial-brachial hypoesthesia and headache. A cerebral computed tomography revealed a right frontal cortical bleeding tumour, being diagnosed as a glioblastoma multiforme. The patient was discharged 15 days after admission and was proposed for neurosurgery.
Leffert L, Schwamm L. Neuraxial anesthesia in paturients with intracranial pathology: a comprehensive review and reassessment of risk. Anesthesiology. 2013;119:703–18. doi: https://doi.org/10.1097/ALN.0b013e31829374c2
Curatolo P, Bombardieri R, Jozwiak S. Tuberous sclerosis. Lancet. 2008;372:657. doi: https://doi.org/10.1016/S0140 -6736(08)61279-9.
Monteiro T, Garrido C, Pina S, Chorão R, Carrilho I, Figueiroa S, Santos M, Temudo T. [Tuberous sclerosis: clinical characteristics and their relationship to genotype/phenotype]. An Pediatr (Barc). 2014;81(5):289-96. doi: https://doi.org/10.1016/j.anpede.2014.03.001
Tewari KS, Cappuccini F, Asrat t, Flamm BL, Carpenter Se, Disaia PJ, Quilligan eJ: Obstetric emergencies precipitated by malignant brain tumors. Am J Obstet Gynecol. 2000;182:1215–21. doi: https://doi.org/10.1016/s0002-9378(00)70188-8.
Bharti N, Kashyap L, Mohan VK: Anesthetic management of a parturient with cerebellopontine-angle meningioma. Int J Obstet Anesth. 2002;11:219–21. doi: https://doi.org/10.1054/ijoa.2001.0941
Girault A, Dommergues M, Nizard J. Impact of maternal brain tumours on perinatal and maternal management and outcome: a single referral centre retrospective study. Eur J Obstet Gynecol Reprod Biol. 2014;183:132. doi: https://doi.org/10.1016/j.ejogrb.2014.10.027.
Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2016;124:270. doi: https://doi.org/10.1097/ALN.0000000000000935.
Causse-Mariscal, A, Palot M, Visseaux H, Daigremont-Botmans C, Malinovsky JM. Labor analgesia and cesarean section in women affected by tuberous sclerosis: report of two cases. Int J Obst Anesth. 2007;16(3):277–80. doi: https://doi.org/10.1016/j.ijoa. 2006.10.012.
Hebl JR, Horlocker TT, Schroeder DR. Neuraxial anesthesia and analgesia in patients with preexisting central nervous system disorders. Anesth Analg. 2006;103:223. doi: https://doi.org/10.1213/01.ane.0000220896.56427.53.
Toledo P, Malinov AM. Embolic disorders. Chestnut, DH, et al, editors. Chestnut’s Obstetric Anesthesia: Principles and practice. 5th ed. Philadelphia: Elsevier; 2.014. p. 713-733.
Burtis MT, Ulmer JL, Miller GA, Barboli AC, Koss SA, Brown WD. Intradural spinal vein enlargement in craniospinal hypotension. AJNR Am J Neuroradiol. 2005;26:34-8.
Matthew J. Rabito, Alan David Kaye. Tuberous Sclerosis Complex: Perioperative Considerations. Ochsner J. 2014;14(2):229–39.
Abd-Elsayed, Alaa A, et al. A case series discussing the anaesthetic management of pregnant patients with brain tumours. F1000Research. 2 2013;2(92). 2013. doi: https://doi.org/10.12688/f1000research.2-92.v2
Shaikh JM, Memon A, Memon MA, Khan M. Post dural puncture headache after spinal anaesthesia for caesarean section: a comparison of 25g Quincke, 27g Quincke and 27g Whitacre spinal needles. J Ayub Med Coll Abbottabad. 2008;20(3):10-3.
Muhammad SK, Ghulam NM, Safia MS, Maqsood AS. Post dural puncture headache in obstetrics: a comparative study using 25G Whitacre & 27G Quincke needles. Med Channel. 2007;13:45–8.
Bateman BT, Schumacher HC, Bushnell CD, et al. Intracerebral hemorrhage in pregnancy: frequency, risk factors, and outcome. Neurology. 2006; 67:424–9. doi: https://doi.org/10.1212/01.wnl.0000228277.84760.a2.
Reyes D, Prayson R. Glioblastoma in the setting of tuberous sclerosis. J Clin Neurosci. 2015;22(5):907-8. doi: https://doi.org/10.1016/j.jocn.2014.12.001
Trujillo C MC, Barhoum F SS, Meléndez F HJ. Glioblastoma multiforme y embarazo: reporte de caso. Colombian Journal of Anesthesiology. 2012:40(3):235-9. doi: https://doi.org/10.1016/j.rca.2012.05.004
The Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.) is the owner of all copyrights to any articles published in the journal. Published manuscripts become the permanent property of S.C.A.R.E. and may not be published elsewhere without written permission. S.C.A.R.E. keeps the right to use these manuscripts in any form, including print, video, audio and digital.
Creative Commons License
Open-access articles can be read, downloaded and shared on a free basis upon publication. The Journal publishes all articles under the CCBY- NC-ND license. Attribution-NonCommercial-NoDerivs: CC BY- NC-ND. Of the six main licenses, this is the most restrictive because it only allows others to download and share articles as long as they give credit to the author, but they cannot in any way change the paper or use it commercially.