Epidural anaesthesia in von Hippel‐Lindau disease

Abstract

SummaryThe management of childbirth, including epidural anaesthesia for Caesarean section is described in a patient with von Hippel-Lindau disease. The reasons for the choice of epidural anaesthesia are explained and the anaesthetic significance of the disease is discussed.

Malformations vasculaires superficielles : impact sur le suivi de grossesse et prise en charge à l’accouchement

“…L'artériographie sélective et l'embolisation sont utiles chez les patientes neurologiquement stables. Cette embolisation diminue le saignement peropératoire, et parfois, suffit comme seul traitement de l'hémangiome [50]. La radiothérapie, contre-indiquée pendant la grossesse, peut être un adjuvant nécessaire à la chirurgie en postpartum [11].…”

Caesarean section for a woman with Von Hippel-Lindau disease

“…2 The anaesthetic literature is limited regarding ideal anaesthetic management and both neuraxial and general anaesthesia have been used successfully for caesarean section. [5][6][7][8][9][10] Neuraxial blockade could cause cerebellar herniation in patients with raised ICP with either a deliberate or inadvertent dural puncture. There is also the risk of rupturing a spinal haemangioblastoma with either spinal or epidural needle.…”

“…2,3 Nevertheless, there are several case reports of successful use of epidural anaesthesia for caesarean section in women with VHLD. [5][6][7] The pressor response of laryngoscopy, gagging, coughing and cardiovascular instability must be avoided when general anaesthesia is used, as all could increase the risk of bleeding from haemangioblastoma. 2,4 In patients with VHLD it is valuable to have baseline knowledge and evaluation of the extent of their disease.…”

Broken micro-tip spinal needle

“…2 The anaesthetic literature is limited regarding ideal anaesthetic management and both neuraxial and general anaesthesia have been used successfully for caesarean section. [5][6][7][8][9][10] Neuraxial blockade could cause cerebellar herniation in patients with raised ICP with either a deliberate or inadvertent dural puncture. There is also the risk of rupturing a spinal haemangioblastoma with either spinal or epidural needle.…”

“…2,3 Nevertheless, there are several case reports of successful use of epidural anaesthesia for caesarean section in women with VHLD. [5][6][7] The pressor response of laryngoscopy, gagging, coughing and cardiovascular instability must be avoided when general anaesthesia is used, as all could increase the risk of bleeding from haemangioblastoma. 2,4 In patients with VHLD it is valuable to have baseline knowledge and evaluation of the extent of their disease.…”