Introduction: Tuberous sclerosis complex (TSC) is a rare genetic disorder   characterized by the development of benign tumors in multiple organs, including  the brain, skin, kidneys, heart, and lungs. It is often associated with neurological
manifestations such as epilepsy, intellectual disabilities, and behavioral disorders. The management of patients with TSC, particularly those with epilepsy, presents unique challenges during surgical procedures due to their complex medical history
and potential for perioperative complications.  Case Report: A 24 year-old female diagnosed with left renal mass plus left adnexal  mass pelvis posted for left nephrectomy + left adnexal mass excision with a known  diagnosis of tuberous sclerosis complex and a history of epilepsy. It was scheduled  for a left nephrectomy due to a renal angiomyolipoma. The patient had a history of frequent generalized tonic-clonic seizures despite being on antiepileptic medication.  On physical examination, the patient appeared well-oriented with normal cognitive function. Multiple hypopigmented macules were present on her skin,
consistent with her diagnosis of TSC. Preoperative laboratory investigations were  within normal limits. Preoperative evaluation by the neurologist ensured that the  patient’s antiepileptic drug (AED) regimen was optimized. recommended.
Epidural was places at T12-L1; General anesthesia was induced using propofol  and fentanyl, with vecuronium and maintained with O2, N2O and Iso?urane. Antiepileptic medications were given. Vitals were stable and blood was transfused.
Intraoperative and post-operative period patient was stable and monitored in ICU  for 1 day and shifted to postoperative ward uneventfully.  Conclusion: This case highlights the successful anesthetic management of a  patient with tuberous sclerosis complex and epilepsy undergoing nephrectomy. A multidisciplinary approach, careful preoperative planning, and vigilant
intraoperative and postoperative monitoring are essential to minimize   omplications and ensure positive outcomes in such complex cases. Maintaining  seizure control and avoiding perioperative triggers, while ensuring hemodynamic  stability, were key factors in the management of this patient. Key Messages: Our patient was diagnosed as Tuberous sclerosis with skin lesions,  epileptic seizures and a mass in adnexa involving the kidney. This presents with  a complex problems of patient on antiepileptic medications, depression and a vascular tumour which required a thorough pre-anaesthetic workup, optimising
the patient hemodynamically with cover of antiepileptic medications and  perioperative pain relief. We successfully managed without any complications.