Anesthetic Management of A Pregnant Woman With A Cervical Intramedullar Ependymoma

Abstract

Spinal tumors are rare in pregnancy, but their importance arises from caus- ing serious problems in terms of continuing pregnancy. Increased tumor growth or edema, increased vascularity, or pregnancy-related immunotol- erance under hormonal influence constitute or exacerbate the symptoms. A 21-year-old primiparous pregnant woman at 30 weeks gestation was admit- ted with quadriparesis to the Neurosurgery Department with a previous his- tory of numbness and weakness in her right shoulder, bilateral arms, and legs in the 1st trimester, gradually increasing during the pregnancy. Due to the in- creased risk of morbidity, neurosurgical intervention was not delayed. We aimed to present the anesthetic approach in the surgery of a pregnant wom- an with a cervical intramedullary ependymoma. Neuromonitorization of the mother was performed by neurologists and fetal heart monitorization by ob- stetricians. Additionally bispectral index and body temperature was moni- torized. A central venous and an arterial line were established and the pa- tient's position was changed to a sitting position. Partial C2, C3-4 total lam- inectomy and excision of the mass were performed. At the end of the opera- tion, the patient was extubated. Both the fetus and mother were doing well. A multidisciplinary approach and careful consideration of the timing of both surgery and delivery should be considered. Individual case management has to be tailored to the surgical and neuroanesthetic requirements according to gestational age.