Spinal medulloblastoma in pregnancy: A pandora of challenges for the anesthesiologist

Tumors of the spinal column, meninges, nerve roots, or the cord parenchyma itself may compress and damage the spinal cord resulting in neural deficits. The presence of spinal cord tumor itself in pregnancy is a rare occurrence. Rapidly progressive neurological involvement due to compression should be considered for immediate decompression. The specific positioning for surgery and inaccessibility to the airway during surgery makes all spinal surgeries technically challenging for the anesthesiologist. The presence of pregnancy along with this disease further complicates patient management. We present the case of a 24-week-old pregnant female who reported to emergency with decreased sensation in her lower limbs and urinary retention. She was operated previously for cranial medulloblastoma and was on regular follow-up. Magnetic resonance imaging spine revealed multiple intradural extramedullary masses at the D3-4, D8-9, and D10-D11 vertebral levels. Considering her pregnancy and increased risk of surgery during this condition, only the mass causing her symptoms was decided to be operated upon (D10-11). The surgery was done in the prone position, during which, fetal well-being was insured by the obstetric team using transabdominal ultrasonography. Careful padding of pressure points was done; frames on the Allen table were placed in a manner to avoid any pressure on the abdomen during the surgery. The surgery was uneventful, and the patient was successfully reversed and extubated. Fetal heart rate was monitored perioperatively at regular intervals, and ultrasonographic assessment was done by the obstetric team once the patient was extubated. This case highlights the requirement of training the professionals for tackling nonobstetric surgery in a pregnant patient. The increased awareness and education in society regarding perioperative care issues will bring forth new challenges and thus we need to be more prepared for handling such cases.