Intracranial arachnoid cyst: anaesthetic management in pregnancy

Intracranial arachnoid cyst in pregnancy: case report, literature review and evaluation of neuraxial anaesthesia risk

Choosing the type of intrapartum anaesthesia for pregnant women with intracranial arachnoid cysts can be challenging due to a lack of research. We report the intrapartum anaesthetic management of a 25-year-old woman with a known 10 cm arachnoid cyst. By means of a literature review and discussion of safety surrounding neuraxial techniques, this report will help to inform obstetric anaesthesia practice. Overall, in the absence of raised intracranial pressure, neuraxial analgesia and anaesthesia during the intrapartum period appears to be a safe option.

Pregnancy in an Asymptomatic Woman with Porencephalic and Arachnoid Cysts

A 25-year-old woman presented to the obstetric clinic in her first pregnancy. The patient was accompanied by her mother who reported an episode of intracerebral hemorrhage after birth and also remembered access to the emergency department after generalized tonic-clonic seizure as an infant. She was not able to describe the therapy for seizure preventions and even when and why it was suspended, but she affirmed that no residual neurological consequences were detected in the following years. Actually, the pregnant woman was in good health without neurological symptoms nor assumed any therapy. A neurologist reviewed the patient's CT scan in which arachnoid cyst and porencephalic cyst were evident, and he assessed that no abnormalities were found in motor, sensory, and mental state examination. EEG did not show any epileptiform or seizure-like activity. No antiepileptic drug was prescribed due to the absence of symptoms since many years. The patient had no neurological symptoms during pregnancy or obstetric complications and delivered at term a healthy baby through a caesarean section. She breastfed, and after two years, the patient and the baby are healthy. The association of porencephalic and arachnoid cyst in pregnancy is an extremely rare neurological condition that needs a multidisciplinary counseling in pregnancy, but an uneventful course is possible.

Intracranial arachnoid cysts and obstetric anesthesia: two case reports

Two cases of patients in whom neuraxial anesthesia was planned for labor and delivery and who had a pre-existing intracranial arachnoid cyst are reported. Anesthesia was used in one patient and was uneventful. The pathophysiology of these cysts and factors which can precipitate the occurrence of symptoms, are reviewed and cases previously described in the literature are examined. Management should be individualized and based on evaluation of preexisting neurological symptoms. In most cases and although CT scan and MRI images may show an intracranial cyst with impressive development, patients remain asymptomatic and neuraxial regional anesthesia can be used safely, provided the patient has agreed and the neurologist in charge has been informed.