Anaesthetic Management of a Cerebellopontine Angle Tumour in a Primigravida Undergoing Craniotomy: A Case Report

Cerebellopontine Angle (CPA) tumours are uncommon intracranial neoplasms that can present significant anaesthetic challenges, particularly in pregnant patients. The physiological, hormonal, and anatomical changes of pregnancy can mask neurological symptoms, delay diagnosis, and complicate both surgical and anaesthetic management. The authors report a rare case of a 22-year-old primigravida at 14 weeks of gestation who presented with progressive blurring of vision and left-sided tinnitus. Magnetic Resonance Imaging (MRI) revealed a large left CPA lesion compressing the fourth ventricle. She had a history of Ventriculoperitoneal (VP) shunt placement for hydrocephalus two weeks prior. The patient was subsequently planned for an elective left retromastoid suboccipital craniotomy. The procedure was performed under Total Intravenous Anaesthesia (TIVA) using propofol and dexmedetomidine, with continuous neurophysiological monitoring to preserve cranial nerve function. Muscle relaxants were avoided following intubation to facilitate Electromyographic (EMG) monitoring. Haemodynamic stability and foetal heart rate were maintained throughout the eight-hour procedure. The patient was electively ventilated overnight, extubated on the first Postoperative Day (POD) without neurological deficits, and postoperative imaging confirmed complete tumour excision. She later delivered a healthy male infant at 36 weeks via elective caesarean section. The present case highlights the successful perioperative management of a large CPA tumour during early pregnancy, where the timing of surgery, meticulous use of TIVA without muscle relaxants, and continuous foetal and cranial nerve monitoring ensured favourable maternal and foetal outcomes.