P090 Pregnancy, cerebellar cavernomas and Von Willebrand’s disease: a case report

<h3>Background and Aims</h3> Cerebral Cavernomas are vascular malformations that occur in 0.1–0.5% of the population. Despite the highly variable natural history and symptomatic presentation, they all pose a significant concern: cerebral hemorrhage. Among several risk factors, including an inherited bleeding disorder, delivery presents as another crucial one. <h3>Methods</h3> A 29-year-old pregnant woman, previously diagnosed with 3 cerebellar cavernomas and Von Willebrand’s disease, was admitted for elective caesarian section at 39 weeks. The case required multidisciplinary planning between anesthesia, hematology, neurology and obstetrics. Considering the patient‘s space-occupying lesion stability and hemorrhagic risk, epidural anesthesia was proposed. <h3>Results</h3> No changes were observed regarding clot factors and ratios. Blood typing and 1 g tranexamic acid were accomplished before neuroaxial approach. While monitored following ASA standards, we proceeded with a lumbar epidural catheter. Here, 90 mg of ropivacaine and 10 mcg of sufentanil were administered, with a total volume of 13 mL, achieving a sensitive block up to T4 level. The surgery and post operative period elapsed without any events and the woman was discharged at day 3 post-surgery. <h3>Conclusions</h3> Currently there is no consensus regarding anesthetic approach in cerebral cavernomas. Generally, hemorrhage prevention is the main goal, and so are sudden variations in intracranial pressure. Neuroaxial anesthesia emerges as a valid option in obstetrics, since it avoids airway manipulation and hemodynamic changes associated to general anesthesia. This case required careful management of a patient with high-risk conditions for intracranial hemorrhage. Epidural anesthesia proved to be a valid choice, avoiding such severe outcome.