Obstetric and anesthetic management of parturients with intracranial neurovascular abnormalities

No definite recommendations exist for anesthetic and obstetric management of pregnant patients with intracranial neurovascular disorders during delivery. This case series describes the management of pregnant patients with intracranial vascular abnormalities during delivery.

Information was gathered from institutional databases to include pregnant patients evaluated by neurology or neurosurgery at a single institution between January 2000 and August 2025 for any central nervous system vascular abnormality. Patients were included if evaluation by neurology or neurosurgery occurred either before, during pregnancy, or up to six months post-partum.

The study cohort consisted of 26 patients having 31 deliveries. The most common lesions were cavernous malformation (n = 8) and cerebral arteriovenous malformation (n = 8). The remainder had aneurysm (n = 4), dural arteriovenous fistula (n = 2), moyamoya disease (n = 2), venous angioma (n = 1), and carotid dissection (n = 1). Twenty-one deliveries were vaginal and 10 were cesarean delivery (CD). The presence of a neurovascular abnormality was an indication for induction of labor in three individuals and for CD in four deliveries. Neuraxial labor analgesia was used in 14 of the 21 patients who had vaginal delivery. Parturients who underwent CD had spinal anesthesia (n = 8), preexisting labor epidural anesthesia (n = 1), and general anesthesia (n = 1). There were no complications attributed to neuraxial anesthesia.

The presence of central nervous system vascular abnormalities in pregnant patients is rare but poses unique challenges to obstetric and anesthetic management. Neuraxial anesthesia and analgesia can be offered to women with central nervous system vascular abnormalities without abnormal neurologic symptoms.