Abstract

Cervical Vagal Schwannoma is a rare, slow-growing nerve-sheath tumour often associated with neurofibromatosis types I and II, both autosomal dominant disorders. Though these tumours are typically benign, but present with unique challenges in parturients, especially concerning airway management and selection of appropriate anaesthetic techniques. In this case, a 25-year-old pregnant female, presented at 37.6 weeks for an emergency lower segment caesarean section with a history of a Cervical Schwannoma & no other comorbidities, Airway examination MPC grade III. Due to the absence of intradural extension of the tumour, limited neck movement and reduced mouth opening, subarachnoid block was chosen over general anaesthesia. The surgery was uneventful, with slight autonomic dysreflexia managed intraoperatively. The patient delivered a healthy baby, and the postoperative course was stable with no neurological deficits. This case highlights importance of thorough preoperative neuroimaging and careful anaesthetic planning in managing pregnant patients with Schwannomas to minimize complications.

• 1.   Ayoub E.L., Fahd E.L., Elhasnaoui M.A., El koundi A. Neurofibromatosis during pregnancy, what about anesthesia? Anaesth Pain Intensive Care 2020; 24(6): 650–652.
• 2.   Ozawa H., Onoda Y., Aizawa T., et al. Natural history of intradural–extramedullary spinal cord tumors. Acta Neurologica Belgica 2012; 112: 265–70.
• 3.   Srinithi A., Prasad T.K., Rajarajeswaran K. Type-II Neurofibromatosis with Cervical Schwannoma Posted for Emergency Lower Segment Cesarean Section under Sole Epidural Technique. J Basic Clin Appl Health Sci 2022; 5(1): 15–16.
• 4.   Spiegel J.E., Hapgood A., Hess PE. Epidural anesthesia in a parturient with neurofibromatosis type 2 undergoing cesarean section. Int J Obstet Anesth 2005;14(4):336–339.
• 5.   Chamberlain M.C., Tredway T.L. (2011) Adult primary intradural spinal cord tumors: a review. Curr Neurol Neurosci Rep 11: 320-328.
• 6.   Youngs P., Human M. Epidural haematoma in a parturient with neurofibromatosis. Br J Anaesth 2002; 88(5): 745.
• 7.   Thakkar, S., Feigen, U. & Mautner, V.F. Spinal tumours in neurofibromatosis type 1: an MRI study of frequency, multiplicity and variety. Neuroradiology 1999; 41(9): 625–629.
• 8.   Galvan J.M., Hofkamp M.P. Usefulness of intrapartum magnetic resonance imaging for a parturient with neurofibromatosis type 1 during induction of labor for preeclampsia. Proc (Bayl Univ Med Cent) 2018; 31(1): 92-93.
• 9.   Wise J. Maternity care: Remifentanil is recommended as alternative to epidural in draft guidance. BMJ 2023 Apr 25; 381: 946.
• 10.   Kranke P, Girard T., Lavand’homme P., Melber A., Jokinen J., Muellenbach R.M., et al. Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural”. BMC Pregnancy Childbirth 2013; 13: 139.

Data Sharing Statement

Funding