Background and Aims Large acoustic neuromas can rarely be present during pregnancy, which could increase the growth of the tumor, making the anaesthetic management a challenging procedure, especially when dealing with a high BMI parturient.

Methods A 39 year old primigravida presented at 25 weeks gestation with blurred vision, gait imbalance and right facial paresis. Fundoscopy showed bilateral papilledema and MRI revealed a large right cerebellopontine angle mass, compressing brain stem and 4th ventricle. Tumor resection delayed until after delivery, provided there was no worsening of the neurological symptoms. The patient, ASA II with BMI 38, scheduled for cesarean section at 37 weeks gestation. Due to raised intracranial pressure (ICP), neuraxial block was contraindicated. Main concern with general anaesthesia was to prevent any further increase in ICP and be prepared to manage a possible difficult airway, which could lead to hypoxaemia and hypercapnia, increasing ICP.

Preoperatively, an available bed in Intensive Care Unit was requested, in case there were any intraoperative complications and an invasive blood pressure monitoring was introduced. Patient was placed in ramped position with left uterine displacement and rapid sequence induction to anaesthesia with cricoid pressure was performed.

Results There were no intraoperative complications and extubation was uneventful. Newborn’s APGAR score was 9¹/10⁵.

Conclusions Multidisciplinary and cooperative team approach in this challenging case, together with an effectively planned perioperative anaesthetic management, led to a positive outcome for both mother and newborn.