title: Neuraxial anesthesia in parturients with intracranial pathology: a comprehensive review and reassessment of risk.
abstract: Parturients with intracranial lesions are often assumed to have increased intracranial pressure, even in the absence of clinical and radiographic signs. The risk of herniation after an inadvertent dural puncture is frequently cited as a contraindication to neuraxial anesthesia. This article reviews the relevant literature on the use of neuraxial anesthesia in parturients with known intracranial pathology, and proposes a framework and recommendations for assessing risk of neurologic deterioration, with epidural analgesia or anesthesia, or planned or inadvertent dural puncture. The authors illustrate these concepts with numerous case examples and provide guidance for the practicing anesthesiologist in determining the safety of neuraxial anesthesia.
authors.affiliation: Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital and Assistant Professor of Anesthesia, Harvard Medical School, Boston, Massachusetts, USA. lleffert@partners.org
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Leffert
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000009:adverse effects* / Q000379:methods; D001810:Blood Volume; D001921:Brain / Q000033:anatomy & histology; D002555:Cerebrospinal Fluid / Q000502:physiology; D002560:Cerebrovascular Circulation; D004677:Encephalocele / Q000503:physiopathology*; D006801:Humans; D007268:Injections, Epidural; D007427:Intracranial Pressure; D018570:Risk Assessment; D013129:Spinal Puncture / Q000009:adverse effects*