{"id":"1c554102-ba17-4c48-84de-22cd5cbf4ff8","slug":"lumbar-epidural-analgesia-for-labor-in-a-parturient-with-a-history-of-surgery-for-lumbar-intradural-ependymoma-literature-review-and-case-presentation","title":"Lumbar epidural analgesia for labor in a parturient with a history of surgery for lumbar intradural ependymoma: Literature review and case presentation","authors":["Ramsis F. Ghaly","Tatiana Tverdohleb","Kenneth D. Candido","Nebojsa Nick Knezevic"],"abstract":"Background: Ependymomas represent 50–60% of all brain and central nervous system tumors. Previous lumbar spine surgery for resection of an ependymoma should not be considered a relative contraindication for the administration of epidural/subarachnoid anesthesia to patients in labor. Case Description: A 34-year-old G1P0, who underwent resection of an L1-L3 intramedullary ependymoma 8 years previously, presented in active labor with residual left leg numbness and tingling. The lumbar magnetic resonance imaging showed scar tissue and the L1-L3 laminectomy defect. With the acute onset of labor pain, the patient underwent continuous lumbar epidural analgesia; the epidural catheter was placed at the L5-S1 level. The patient underwent an emergency cesarean section with surgical anesthesia being attained up to a T4 dermatomal sensory level. Conclusions: Neuraxial anesthesia can be performed safely in patients who have previously undergone lumbar resections of intradural ependymomas. However, the anesthesiologist should place the epidural needle/catheter at a nonoperative level (e.g. above/below). Furthermore, epidural local anesthetics and opioids, as in this case, placed at the L5-S1 level below an L1-L3 prior surgical scar, may diffuse intradurally, bypassing the obliterated surgical epidural space and/or attendant scar tissue.","thumbnailUrl":null,"publishDate":"2018-10-23T00:00:00.000Z","doi":"10.4103/sni.sni_490_17","categories":["Neuroanesthesia and Critical Care","Case Report"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2018/10/9046/SNI-9-211.pdf"}