Anaesthestic management of a case of plexiform Neurofibroma in a pediatric patient: A case report

Plexiform neurofibroma is a rare and complex manifestation of neurofibromatosis type 1 (NF1), known for its infiltrative growth, high vascularity, and potential for malignant transformation. Anesthetic management in such cases, especially in pediatric patients, poses significant challenges due to difficult airway access, potential for massive blood loss, and proximity to critical neurovascular structures. This case report presents the anesthetic considerations for a 3-year-old male child with a large plexiform neurofibroma involving the occipital and right temporal bones, measuring 6.2 x 5.1 x 13.3 cm. The tumor significantly restricted neck extension, complicating airway management. A carefully tailored anesthetic plan was implemented, including premedication, induction with ketamine and succinylcholine, and intubation using a C-MAC video laryngoscope. Invasive monitoring with arterial and central venous lines was established to manage anticipated blood loss. The child received intraoperative transfusion and muscle relaxation was maintained with atracurium. Postoperatively, the child was extubated and recovered uneventfully. This case underscores the importance of meticulous preoperative planning, anticipation of difficult airway and hemorrhage, and a multidisciplinary approach to ensure safe anesthetic management in pediatric patients with complex cranial plexiform neurofibromas.