Taka Hitomi, Kusama Nobuyoshi, Sakamoto Minami, Sasano Nobuko, Tanaka Motoshi
Department of Anesthesiology and Intensive Care Medicine, Nagoya City University West Medical Center, 1-1-1, Hirate-Cho, Kita-Ku, Nagoya, Aichi, 462-8508, Japan.
Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
JA Clin Rep. 2024 Oct 1;10(1):61. doi: 10.1186/s40981-024-00745-w.
Dural ectasia is a common manifestation of neurofibromatosis type 1. Although there have been reports of unsuccessful spinal anesthesia due to dual ectasia in Marfan syndrome, reports describing similar unsuccessful spinal anesthesia in neurofibromatosis type 1 are lacking.
A parturient with neurofibromatosis type 1 was scheduled for a repeat cesarean section. During a previous cesarean section, she had experienced a failed spinal anesthesia, which resulted in a conversion to general anesthesia. Preoperative lumbar magnetic resonance imaging revealed dural ectasia, which was speculated to be the cause of the previous spinal anesthesia failure. Therefore, combined spinal-epidural anesthesia was implemented. Because the block level of spinal anesthesia was insufficient as predicted, supplemental administration of epidural anesthesia successfully provided adequate analgesia for the surgery.
Combined spinal-epidural anesthesia can be useful for the management of cesarean sections in patients with neurofibromatosis type 1-associated dural ectasia.
硬脊膜扩张是1型神经纤维瘤病的常见表现。虽然已有因马方综合征患者硬脊膜扩张导致脊麻失败的报道，但缺乏关于1型神经纤维瘤病患者类似脊麻失败情况的报道。
一名患有1型神经纤维瘤病的产妇计划行再次剖宫产术。在之前的剖宫产术中，她经历了脊麻失败，最终改为全身麻醉。术前腰椎磁共振成像显示硬脊膜扩张，推测这是之前脊麻失败的原因。因此，实施了腰麻-硬膜外联合麻醉。由于正如预期的那样腰麻的阻滞平面不足，硬膜外麻醉的补充给药成功为手术提供了充分的镇痛。
腰麻-硬膜外联合麻醉可用于管理患有1型神经纤维瘤病相关硬脊膜扩张的患者的剖宫产手术。
