Background and Aims The incidence of unruptured intracranial aneurysm is 2% of the general population with a significant prevalence in the generative period, when the risk of rupture is more pronounced. The main feature is accidental detection due to non-specific resistant headaches.

Methods Our case report shows the anesthetic management of caesarean section in the presence of an unruptured basilar artery aneurysm

Results 36-year-old pregnant woman was prepared for a caesarean section under neuraxial anesthesia based on neurosurgical recommendations according to an accidentally discovered unruptured aneurysm of the basilar artery. One year ago, she was regularly monitored neurologically and radiologically, perioperatively without neurological expression. She denied allergies, and stated regular antiarrhythmic therapy (Verapamil tbl 40mg). Pre-anesthetic examination revealed unremarkable vital signs. The anesthetic technique of choice was epidural anesthesia, L3-L4 level and administration of local anesthetic – levobupivacaine 0.5% with opioid adjuvant – fentanyl. Concomitantly, a ephedrine infusion was started and continuously titrated to maintain systolic and mean arterial pressure. Intraoperatively and postoperatively, the emphasis was on hemodynamic stability. Pain control was provided regularly for 6 hours with Levobupivacain 0.25% with opioid adjuvant. The patient did not exhibit any neurological deficits.

Conclusions The relationship between the mode of delivery and risk for aneurysm rupture is not well defined. The decision on anesthetic management is significantly influenced by the physiological changes of pregnancy because they increase the risk of aneurysm rupture as a result of sudden changes in intracranial pressure. Hemodynamic stability is crucial for safe and secure anesthesia and controlling the risk of aneurysm rupture