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Description
The diagnosis of intracranial tumors during pregnancy presents significant challenges for anesthetic and obstetric management. Gestational meningiomas account for approximately 15% of intracranial tumors in reproductive-age women.1 Pregnancy-related hormonal and hemodynamic changes may accelerate tumor growth and worsen neurologic symptoms, increasing maternal and fetal risk.1-3 Management requires careful evaluation of multiple factors. While neuraxial anesthesia is commonly used in obstetrics, it has traditionally been contraindicated in patients with elevated intracranial pressure, whereas general anesthesia carries risks related to airway management and uterine effects.3,4 Evidence guiding anesthetic choice remains limited and largely based on case reports.3-7 Currently, no standardized guidelines exist to define when neuraxial anesthesia is considered "safe" in these patients.
A 32-year-old gravida 1 para 0 woman at 36 weeks' gestation presented to the emergency department after a witnessed seizure occurring during sleep. She had no prior seizure history and a medical history notable only for Sjögren syndrome. Neuroimaging revealed a large right parasagittal intracranial mass measuring approximately 6 cm with associated midline shift, concerning for meningioma. The patient remained neurologically intact and asymptomatic following the single seizure episode and was started on levetiracetam. Neurology, neurosurgery, maternal-fetal medicine, obstetrics, and anesthesiology were consulted.
This case highlights the importance of individualized anesthetic decision-making in cesarean delivery for patients with intracranial pathology. Although neuraxial anesthesia is traditionally discouraged in this setting, it may be an option that can be considered in carefully selected pregnant patients with stable neurologic status, reassuring imaging, and multidisciplinary planning.3,4,6,7 Identifying clinical and radiographic features which predict acceptable patient risk remains a potential area of future research that would help guide clinical decision making.
Publication Date
5-8-2026
Recommended Citation
Asuncion H, mcDaniel R, Korn M. Anesthetic considerations for cesarean delivery in the setting of newly diagnosed intracranial mass. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.
Comments
2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2027