Anesthesia for Cesarean section and posterior fossa craniotomy in a patient with von Hippel-Lindau disease

Abstract

Purpose: To describe the care of a pregnant woman with von Hippel-Lindau disease (VHLD) and intracranial mass lesions. Clinical features: A 30-yr-old primigravida with VHLD at 35 weeks gestation was seen at the obstetric anesthesia clinic because she wished an epidural analgesia during labour. She had a history of headaches and dizziness. Further investigations showed an enlarged cerebellar hemangioblastoma with significant local mass effects. A combined Cesarean section delivery and posterior fossa craniotomy was performed at 37 weeks gestation. A general anesthetic with fentanyl, rocuronium, nitrous oxide, oxygen and isoflurane was given for Cesarean section delivery. After delivery, isoflurane was reduced and propofol infusion at 4-8 mg·kg-1·hr-1 was initiated. The patient had an uneventful operative course and recovery. Conclusions: Patients with VHLD may have worsening of preexisting lesions or develop other lesions during pregnancy. Some asymptomatic lesions can increase the risk for anesthesia complications. These patients need comprehensive assessment before administration of anesthesia.