Anesthetic management of idiopathic intracranial hypertension during pregnancy. A case report

Abstract

Idiopathic intracranial hypertension (IIH) is a condition characterized by elevated intracranial pressure (ICP) of unknown etiology, more prevalent in obese women of childbearing age. The management of IIH during pregnancy represents a multidisciplinary challenge, as medical treatment is contentious due to the foetal teratogenic risk, and the technically challenging placement of a ventriculoperitoneal shunt is hindered by the presence of the pregnant uterus. The goal of anaesthetic management during childbirth is to maintain hemodynamic stability, cerebral perfusion pressure, and cerebral tissue oxygenation, while avoiding abrupt fluctuations in intracranial pressure. The choice of anaesthetic technique is complex and depends on the assessment of risks and benefits associated with each technique, involving a decision between neuraxial anaesthesia and general anaesthesia. We present the case of a pregnant woman with rapidly progressing IIH, approached in a multidisciplinary manner, whose anaesthetic management was technically challenging, resulting in a favourable outcome without subsequent complications.

Keywords: Anestesia espinal; Anestesia obstétrica; Gestación; Hipertensión intracraneal idiopática; Idiopathic intracranial hypertension; Neurosurgical procedures; Obstetrical anesthesia; Pregnancy; Procedimientos neuroquirúrgicos; Spinal anesthesia.