Primary brain tumors and pregnancy rarely occur together and the incidence of medulloblastoma in pregnancy is still rarer. We describe a 19-yr-old woman in the 30th week of pregnancy who underwent emergency surgery in the sitting position for a posterior fossa medulloblastoma which was causing significant mass effect. Continuous monitoring of both mother and fetus was performed. Particular attention was given to maintain stable maternal hemodynamics and to detect venous air embolism. The surgical procedure and postoperative period were uneventful. This case demonstrates that when absolutely necessary, anesthesia and neurosurgery for posterior fossa lesions can be successful during the third trimester of pregnancy. Furthermore, with meticulous intraoperative monitoring, the operation can be performed safely with the patient in the classical sitting position. Implications Statement: Anesthesia and neurosurgery for posterior fossa lesions can be performed safely in the sitting position during the third trimester of pregnancy. Introduction The frequency of non-obstetric surgery during pregnancy is low, approximately 2 per 1000 cases. 1 The main reasons for such interventions are emergency intra-abdominal disorders. Central nervous system disorders seldom require immediate surgical attention, and cases that do are usually vascular in nature, such as subarachnoid hemorrhage. The incidence of subarachnoid hemorrhage is estimated to be approximately 1 per 2500 pregnancies, 2 while the concurrence of primary brain tumors and pregnancy is even rarer. Although a sufficiently large epidemiologic study concerning the incidence of brain tumors during pregnancy has not yet been carried out, several authors have claimed that the incidence of such tumors may be lower than that in non-pregnant women. 3,4,5,6. We report a case of a 19-yr-old woman in the 30th week of pregnancy who underwent emergency craniectomy in the sitting position for medulloblastoma. Case Description A 19-yr-old woman in the 30th week of pregnancy (as per ultrasonography) presented with complaints of severe headache and vomiting since one month. She had no previous medical history and the pregnancy had been uneventful till then. An MRI scan of brain showed a SOL in the posterior fossa (3.2 × 3.1 × 2.8 cm). She was admitted to the neurosurgery department and was treated conservatively with corticosteroids and mannitol to lower her intracranial pressure. In consultation with the obstetric department, it was decided to perform a caesarian section around the 34 th week of gestation, following which definitive neurosurgery was planned. However, she clinically deteriorated within the next forty eight hours and became drowsy and unresponsive to verbal commands. It was then decided to perform emergency craniectomy while attempting to conserve the pregnancy. The condition of the fetus was good, and all laboratory values were within normal limits.The patient (weight 56kg) was given ranitidine 50 mg iv prior to surgery. Before induction, a wedge was placed under the right hip to displace the uterus to the left and increase vena caval blood flow. After preoxygenation, anesthesia was induced with 1 mg of midazolam, 100μgm fentanyl and 300 mg thiopentone intravenously. Rocuronium 50 mg was used to facilitate orotracheal intubation and the relaxant used for maintenance was vecuronium. Sellicks maneuver was used to prevent aspiration of gastric contents. Anesthesia was maintained with low-dose isoflurane (0.5%) and 50% nitrous oxide in oxygen, with continuous infusion of fentanyl 0.15–0.25 mg/hour. In addition to standard monitoring (ECG, pulse oximetry, oxygen analyzer, end-tidal carbon dioxide concentration, urine output), invasive arterial pressure, central venous catheter and esophageal stethoscope were used. Fetal heart rate was monitored using a fetoscope and the obstetricians were standby to intervene in case of fetal compromise. With constant monitoring of central venous pressure,
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