Neuraxial Anesthesia in Parturients with Intracranial Pathology: A Comprehensive Review and Reassessment of Risk

@article{Leffert2013NeuraxialAI,
  title={Neuraxial Anesthesia in Parturients with Intracranial Pathology: A Comprehensive Review and Reassessment of Risk},
  author={Lisa Leffert and Lee H. Schwamm},
  journal={Anesthesiology},
  year={2013},
  volume={119},
  pages={703–718}
}
Parturients with intracranial lesions are often assumed to have increased intracranial pressure, even in the absence of clinical and radiographic signs. The risk of herniation after an inadvertent dural puncture is frequently cited as a contraindication to neuraxial anesthesia. This article reviews the relevant literature on the use of neuraxial anesthesia in parturients with known intracranial pathology, and proposes a framework and recommendations for assessing risk of neurologic… 
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References

SHOWING 1-10 OF 159 REFERENCES
Anesthetic management of a parturient with cerebellopontine-angle meningioma.
Cerebellopontine-angle meningioma is a rare intracranial neoplasm. It presents a difficult problem in pregnancy. A 27-year-old multigravida presented with headache, vomiting and visual disturbances…
Anesthetic management for cesarean section in a patient with rupture of a cerebellar arteriovenous malformation.
Anesthetic management for cesarean section in moyamoya disease: a report of five consecutive cases and a mini-review.
Brain tumor presenting with fatal herniation following delivery under epidural anesthesia.
TLDR
A pregnant woman with an occult brain tumor who received an epidural anesthetic for relief of labor pain, which was complicated by an inadvertent lumbar puncture, had fatal transtentorial brain herniation several hours after delivery.
Neurosurgery in pregnancy.
TLDR
Surgical and anesthetic issues that are important in dealing with neurosurgical conditions in pregnant women include meningiomas and pituitary adenomas, which may increase in size and require urgent surgical decompression because of apoplexy, and disc ruptures, which can usually be treated conservatively.
Epidural anesthesia for a patient with moyamoya disease presenting for cesarean section.
TLDR
The successful use of epidural anesthesia is reported in the management of a term parturient with moyamoya disease undergoing cesarean section and bilateral tubal ligations.
Anesthetic Management of a Parturient With an Incompletely Resected Cerebral Arteriovenous Malformation
TLDR
A parturient, with a recent subtotal resection of a cerebral arteriovenous malformation, who presented for delivery of a viable male fetus, was scheduled for an elective labor induction, with early epidural analgesia advocated as a strategy to minimize the cardiovascular changes of labor and prevent involuntary Valsalva maneuvers.
Benign intracranial hypertension and anaesthesia for caesarean section.
Anaesthetic management of a parturient with moyamoya disease.
TLDR
A case of moyamoya disease for emergency Caesarean section at 37 weeks of gestation is reported, with no neurological deficit and the patient was discharged with a healthy baby four days after the surgery.
Neurologic issues and obstetric anesthesia.
TLDR
The aim of this discussion is to provide an obstetric anesthesiologist's perspective on regional anesthesia and its implications in obstetrics, and to enhance communication between the authors' specialties.
...
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