Intracranial Ewing Sarcoma in Pregnancy: Anesthetic and Clinical Challenges

We report an unusual case of a 26-year-old female patient diagnosed with primary intracranial Ewing sarcoma (ES) at 16 weeks' gestation. She had vertigo, vomiting, and worsening visual disturbances. MRI showed a solid-cystic mass in the left occipital area with a midline shift. Neurosurgical resection was performed under general anesthesia, with careful intraoperative management to ensure maternal stability and fetal safety. Unique considerations in our anesthesia technique for pregnancy were the management of cerebral blood flow, increased intracranial pressure, and avoiding teratogenic medications. Throughout the intraoperative period, maternal hemodynamic parameters were closely tailored, at times requiring transfusion due to significant bleeding. Postoperative CT imaging showed standard imaging changes consistent with surgical resection and no immediate complications. Fetal monitoring via obstetric ultrasound was normal. Results of histopathology confirmed ES. Here, we discuss the rarity of an intracranial ES occurring during pregnancy and the contours of anesthesia practice in this patient with a complex perioperative process. Coordinating care and developing an individualized plan is crucial to support the best outcome for the mother and fetus.