The Complex Triad of Pregnancy, Neurosurgery, and Anesthesia: Insights from a Single-Center Case Series and Literature Review

Abstract Neurosurgical intervention during pregnancy is rare but unavoidable in life-threatening conditions. Between January 2021 and January 2025, nine pregnant patients underwent neurosurgical procedures under general anesthesia at our tertiary care center. Indications included traumatic brain injury, intracranial tumors, subarachnoid hemorrhage, and sellar lesions. In five cases, surgery was combined with cesarean delivery. Despite the physiological complexities of pregnancy, all procedures were completed without intraoperative maternal complications. When pregnancy was continued, neonatal outcomes were favorable at discharge. In cases requiring termination followed by neurosurgery, one triplet pregnancy resulted in a single neonatal survivor, whereas in another case the child remained well, but the mother succumbed 4 months later due to disease recurrence. These cases suggest that neurosurgical procedures can be safely performed during pregnancy when supported by multidisciplinary coordination, careful anesthetic planning, and individualized decision-making.