Simultaneous Emergency Cesarean Delivery and Decompressive Craniectomy for Meningioma in a Parturient with Systemic Lupus Erythematosus - A Case Report and Literature Review

A strong association is reported between the level of sex hormones and an accelerated growth of meningioma in a parturient. Consequently, a rapidly enlarging, symptomatic intracranial meningioma poses grave risk to the mother and fetus, warranting emergency craniectomy as a life-saving measure regardless of the status of pregnancy. Comorbidities such as systemic lupus erythematosus (SLE) may complicate the perinatal management. Raised intracranial pressure (ICP), hemodynamic Instability, maintaining cerebral and utero-placental perfusion coupled with administering general anesthesia (GA) in a parturient with inherent difficult airway are some of the anesthetic challenges. SLE, an autoimmune, multisystem inflammatory disorder presents unique anesthetic implications in obstetrics due to its variable manifestation depending upon the extent of systemic involvement, acute exacerbations and therapeutic interventions. We present a case of emergency lower segment cesarean section (LSCS) with simultaneous decompressive craniectomy for meningioma in a 41-year-old, 32-week-parturient comorbid with SLE. She presented to the emergency room with headache, confusion, right-sided hemiparesis, ptosis of the left eye and bradycardia. Magnetic resonance imaging revealed left frontal-parietal meningioma causing mass effect along with uncal and subfalcine herniation. An urgent multidisciplinary conference decided to perform emergency cesarean delivery followed by decompressive hemicraniectomy in the same sitting under GA. This is a first such case report that discusses the anesthetic management of a parturient comorbid with SLE and intracranial meningioma undergoing emergency decompressive hemicraniectomy and LSCS under GA simultaneously. We aim to highlight the multidisciplinary approach, expert anesthetic management and tertiary care hospital resources which helped to optimize the management of such a complex case.