DOI: 10.1097/01.aoa.0000308334.74251.52

,  

Issn Print: 0275-665X

Publication Date: 2008/03/01


Print

Intracranial Arachnoid Cyst: Anesthetic Management in Pregnancy

M.M. Rupasinghe; L. McLoughlin; V. Singaraju

    loading  Checking for direct PDF access through Ovid

Excerpt

Arachnoid cysts are fluid-filled cavities in the arachnoid mater and may be intracranial or extracranial. Patients may present with headache and neurologic signs or acutely with rupture and its complications. Usually congenital in origin, the cysts do not usually communicate with the ventricular system and are not filled with cerebrospinal fluid but with fluid secreted by their own cells derived from the subdural neurothelium in the cyst lining. Surgical intervention is indicated to relieve recurrent seizures, raised intracranial pressure or compressive effects.
A 32-year-old G2, P1 patient was referred at 15 weeks' gestation for anesthetic assessment. Fifteen years earlier, she had a 48-hour history of headache, nausea, and photophobia for which a neurologic work-up was negative. Five years later, a neurologic examination was normal. At the age of 27, she had an uneventful spontaneous vaginal delivery after a full-term uneventful pregnancy, during which she received epidural analgesia during labor. Three years later she had blurred vision and headache; ophthalmic examination was normal. However, a few months later she was referred for a 3-day history of fever, headache, dizziness, nausea, and sore throat. Magnetic resonance image brain scanning showed a large 12-cm cyst in the posterior fossa medially and to the right side. Lumbar puncture was performed uneventfully. When she presented for delivery 2 years later, she was adamant that she wanted an elective cesarean section despite assurances that the cyst would not rupture during labor. Clinicians agreed there was no contraindication to spinal or epidural anesthesia. Successful dural puncture was confirmed and diamorphine and hyperbaric bupivacaine were given intrathecally. Surgery proceeded uneventfully and a live healthy girl was delivered (3.28 kg). She was discharged home after 5 days; her recovery was uneventful.
Although intracranial arachnoid cysts are considered benign, they may cause concern over the safety of regional blockade. In the absence of raised intracranial pressure, spinal or epidural anesthesia is appropriate for cesarean delivery. Rupture of a cyst or aneurysmal bleeding into a cyst should be considered in the differential diagnosis of neurologic collapse in pregnancy.

Related Topics

    loading  Loading Related Articles