Background and Aims Neurofibromatosis is a multisystem genetic disorder which manifests with pigmentary skin changes, neurofibromas, increased risk of central nervous system gliomas and other malignant tumors and learning disabilities. Performing an epidural technique in patients with neurofibromatosis is subject to careful consideration due to potential challenges including the presence of neurofibromas involving the spinal cord.
Methods Description of a case of an epidural performed for labour analgesia in a patient with neurofibromatosis.
Results We present a case of a 31-year-old woman, ASA II, 40 weeks pregnant, diagnosed with neurofibromatosis, who was admitted at our hospital in active labour. The patient expressed the will to receive epidural analgesia. She was asymptomatic except for the presence of café-au-lait spots and cutaneous neurofibromas. Her magnetic resonance imaging (MRI) of the brain and spine showed thickening of the optic chiasm and hypothalamus and absence of spinal lesions. There was no history of back pain, headache, neurological deficits or hypertension. Neurological examination was normal, with no sensory or motor deficits. She had normal curvature of the spine. We proceed with the epidural technique. An epidural catheter was placed at L3-L4 level in the midline after finding the epidural space using a loss of resistance to saline technique. There were no complications associated with the technique and the patient had adequate level of analgesia. The patient had a vaginal birth with no complications.
Conclusions The report suggests that epidural labour analgesia may be a suitable option when spinal cord neurofibromas have been ruled out by magnetic resonance imaging and clinical examination.
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