23-year-old primip with incidental finding of Neurofibromatosis
- MRI during pregnancy to assess potential foetal abnormality
- Noted lesions on maternal lumbar spine
- Maternal MRI performed showed ‘thoracic and lumbar spine lesions involving almost all the nerve roots…. Lesion at L3 extends into the spinal canal and deviates cauda equina to the left.’
- Differential diagnosis of Neurofibromatosis or schwannomas
- Asymptomatic, some intermittent back pain
- No skin lesions, vascular involvement, or hypertension
- Uncertain Diagnosis
- Reviewed by geneticist and awaiting phenotype results
- 37 weeks at time of review so may not have confirmed diagnosis by delivery
- Planned for vaginal delivery
- Patient keen for epidural anaesthesia
Suitability for neuraxial anaesthesia
- Consensus opinion that neuraxial would be a safe option
- Epidural vs spinal – considering the lesion at L3 is causing significant compression of the dura, it may be difficult to feed an epidural catheter
- Likely that any neuraxial technique would have an increased likelihood of ineffective or patchy block
- Plan would be for an ultrasound-guided approach, performed early in labour, and a senior proceduralist.
- Space above L3 lesion recommended; L2/3
- See attached BJA article.
- MRI reviewed, agree that neuraxial anaesthesia is safe.
- No brain lesions, therefore, no risk of herniation if Dural puncture
- Advice approach above or below L3