[Peridural anesthesia for cesarean section in a patient with inoperable cerebral angioma]

Anaesthesia for caesarean section in patients with cerebral artero-venous malformations (CAVM) is a controversial matter. We describe a case of a primiparus woman with an inoperable CAVM delivered by CS under epidural anaesthesia. Epidural anaesthesia can be a valid alternative to general anaesthesia as it provides excellent analgesia allowing an accurate assessment of the neurological conditions of the mother and avoiding opioids and/or hypotensive drugs, potentially dangerous to the foetus, to blunt the hypertensive response to intubation. The accidental dural puncture is to be avoided with extra-careful technique. The epidural injection must be made either very slowly or with an incremental technique to avoid any increase in intracranial pressure. Hypotension must be corrected promptly to maintain cerebral perfusion pressure.