神経線維腫症1型合併妊婦に対する帝王切開術の術前評価―脳脊髄MRI検査ができなかった1症例―

A Case Report：Preoperative Assessment without a Cerebrospinal MRI Examination for a Caesarean Delivery in a Patient with Neurofibromatosis 1

要旨

　神経線維腫症1型には無症候の脳脊髄神経線維腫が存在する。合併妊婦は高血圧となりやすく帝王切開率が高い。脊髄幹麻酔は脳ヘルニアや腫瘍穿刺の危険性を有し，全身麻酔は気道確保困難や循環動態変動による脳卒中の危険性を有する。安全な麻酔方法の決定のために，計画的に磁気共鳴画像（MRI）検査を行うことが重要である。

　Asymptomatic cerebrospinal neurofibromas may be present in individuals with neurofibromatosis 1. Pregnant women with neurofibromatosis 1 are prone to hypertension and have a high caesarean-section rate. Neuraxial anesthesia carries the risk of cerebral herniation and tumor puncture, and general anesthesia poses the risk of difficulty securing the airway and stroke due to hemodynamic changes. We performed a caesarean section delivery for a 28-year-old pregnant patient with neurofibromatosis 1, and after consideration of the risk-benefit, spinal anesthesia was performed adequately, without preoperative MRI examination. Due to the lack of an MRI examination, it was difficult to make the consensus for anesthesia among the anesthesiologists, the obstetricians and the patients. The patient had no complication after spinal anesthesia.

　For patients with neurofibromatosis 1, it is important to perform an MRI examination to determine the safest anesthesia regimen.