Anesthetic Management for Caesarean Section and Craniotomy at the Same Session in Pregnant Patient with Spontaneous Cerebellar Hematomas

Abstract

The incidence of spontaneous cerebellar hematomas (SCHs) during late pregnancy is increasing, though still rare. Managing parturients with SCHs poses significant challenges due to the need to balance maternal safety with neonatal considerations, requiring a multidisciplinary approach. This report presents two cases where general anesthesia was used for concurrent Caesarean section and craniotomy. Both patients, at 36 weeks’ gestation, presented with severe headaches, nausea, vomiting, and gait ataxia. MRI scans revealed cerebellar hematomas, necessitating surgical intervention. Both surgeries were successful with stable maternal vital signs and healthy neonates delivered with high APGAR scores. Postoperative recovery was uneventful, and both patients were discharged without neurological deficits. The report emphasizes the importance of rapid induction and recovery, maintaining hemodynamic stability, and ensuring sufficient cerebral perfusion while avoiding fetal depression during such complex procedures.