New diagnosis of neurofibromatosis in pregnancy

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.

Neurosurgical opinion

  • 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