Anaesthetic management of emergency craniotomy for giant intracranial meningioma in pre-viable pregnancy complicated by massive haemorrhage: a case report

Authors

DOI:

https://doi.org/10.66636/gmj.v1.i3.a159

Keywords:

meningioma, pregnancy, emergency craniotomy, neuroanesthesia, massive hemorrhage, pre-viable fetus, intracranial pressure, case report

Abstract

Introduction: Neurosurgical emergencies during pregnancy are rare but pose complex anaesthetic and ethical challenges. Pregnancy-associated physiological changes may accelerate meningioma growth and tumour vascularity, predisposing to acute neurological deterioration. This case documents the integrated, gestational age–specific anaesthetic response to massive intraoperative haemorrhage during emergency craniotomy in a pre-viable pregnancy, providing a clinically translatable framework where evidence-based guidelines are absent.

Case presentation: A 27-year-old woman at 22 weeks’ gestation presented with progressive headache, cognitive decline, and papilloedema. MRI demonstrated a 6.5 × 6.4 cm left temporofrontal meningioma with subfalcine herniation. Emergency frontotemporal craniotomy was performed under general anaesthesia with targeted end-tidal CO₂ management (30–35 mmHg), MAP maintenance ≥80 mmHg, and balanced blood component resuscitation for massive haemorrhage (estimated blood loss 2,500 mL; nadir pH 7.12). Gross total resection was achieved. Postoperative histopathology confirmed WHO Grade I meningioma. Intrauterine fetal demise was confirmed postoperatively.

Conclusion: In pre-viable pregnancy, anaesthetic management of neurosurgical emergencies must prioritise maternal cerebral perfusion and haemodynamic survival. Proactive multidisciplinary planning, gestational age–specific prioritisation, and haemorrhage preparedness are the principal lessons of this case. Given the absence of standardised guidelines, reporting of similar cases may help inform future recommendations.

Keywords: meningioma; pregnancy; emergency craniotomy; neuroanesthesia; massive haemorrhage; pre-viable fetus; intracranial pressure; case report 

References

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Published

08/23/2026

How to Cite

L Pfokreni, & Siba, M. (2026). Anaesthetic management of emergency craniotomy for giant intracranial meningioma in pre-viable pregnancy complicated by massive haemorrhage: a case report. Georgian Medical Journal, 1(3). https://doi.org/10.66636/gmj.v1.i3.a159

Issue

Vol. 1 No. 3 (2026): Surgical Innovation, Paediatrics, and Environmental Health

Section

Case Reports

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Copyright (c) 2026 L Pfokreni, Matte Siba

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