[Anesthesiologic implications of moyamoya disease]

Area of Science:

• Neurology
• Obstetrics
• Anesthesiology

Background:

• Moyamoya disease presents unique challenges in pregnancy, particularly concerning cerebral hemorrhage risk.
• Cerebral hemorrhage in pregnancy necessitates intensive care and mechanical ventilation, posing risks to both mother and fetus.

Observation:

• A 34-year-old pregnant woman at 22 weeks gestation diagnosed with moyamoya disease suffered a cerebral hemorrhage.
• The patient recovered without sequelae and was scheduled for elective cesarean delivery at 38 weeks gestation.
• Preoperative evaluations including echocardiogram, brain CT, and antibody testing were normal.

Findings:

• Intradural anesthesia with bupivacaine and fentanyl was administered for cesarean delivery.
• Continuous monitoring of vital signs and neurological status was maintained throughout the procedure.
• Hemodynamic stability was achieved with intravenous fluids and ephedrine infusion.
• No significant neurological or hemodynamic complications occurred during or after surgery.
• Postoperative analgesia was managed with epidural morphine.

Implications:

• This case highlights the successful management of cesarean delivery in a pregnant patient with moyamoya disease and a history of cerebral hemorrhage.
• Spinal anesthesia can be a safe and effective option for cesarean delivery in select high-risk obstetric patients.
• Multidisciplinary care involving neurology, obstetrics, and anesthesiology is crucial for optimizing outcomes in complex pregnancies.