Neuroprotective General Anesthesia and Invasive Hemodynamic Monitoring for Emergency Cesarean Section in a Parturient with a Giant Vestibular Schwannoma and Obstructive Hydrocephalus: An Observational Analytic Case Study

Abstract

Background. A giant vestibular schwannoma with obstructive hydrocephalus in late pregnancy is a neuro-obstetric dilemma: neuraxial anesthesia risks tonsillar herniation, and general anesthesia must protect cerebral perfusion.

Objective. To describe the anesthetic management, invasive hemodynamic course and conservative postoperative treatment of a parturient with a Koos Grade IV vestibular schwannoma, obstructive hydrocephalus and complete visual loss who needed emergency cesarean section.

Methods. This single case report follows the CARE guideline and was approved by an ethics committee (2025/145). A 35-year-old woman (Gravida 3 Para 1 Abortus 1) at 36 weeks plus 5 days presented with membrane rupture, fetal compromise and blindness from chronic papilledema. Neuraxial anesthesia was avoided. General anesthesia used propofol, atracurium, a remifentanil infusion and sevoflurane, with normocapnia, a controlled oxytocin infusion, and invasive arterial and central venous monitoring.

Results. Mean arterial pressure ranged from 80.3 to 102.7 mmHg (baseline 98.7 mmHg; largest fall -18.6%), and end-tidal carbon dioxide from 35 to 38 mmHg. A male infant (2,600 g; Apgar 8 and 9) was delivered at minute 12, and the patient was extubated awake without coughing. Computed tomography showed a 4.2 × 3.8 × 3.5 cm schwannoma with upward herniation. The family declined shunting; dexamethasone and acetazolamide were given, and she was discharged on day 5. At one year her visual loss was permanent and the infant developed normally.

Conclusion. In this patient, slow-induction general anesthesia with invasive monitoring was followed by hemodynamic stability and a healthy neonate, and medical therapy by stabilization after neurosurgery was declined. One case cannot establish efficacy.