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Management of obstructive hydrocephalus in pregnant patient

1 Department of Orthopedic Surgery, University of California at San Francisco, San Francisco, CA, USA
2 Department of Neurosurgery, Batman State Hospital, Batman, Turkey
3 Department of Neurosurgery, Recep Tayyip Erdoğan University, Rize, Turkey
4 Department of Neurosurgery, Goztepe Medical Park, Istanbul, Turkey

Correspondence Address:
Murat Sakir Eksi,
Department of Orthopedic Surgery, University of California at San Francisco, 500 Parnassus Avenue, MU320 West, San Francisco, CA 94143-0728
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Source of Support: None, Conflict of Interest: None

De novo obstructive hydrocephalus is a rare event during pregnancy. There are only case reports presented in literature. We aimed to discuss the pathophysiological basis and management options with an exemplary case presentation and review of the current literature. A 28-year-old G2P1 patient presented to our clinic with headache, vomiting, and deteriorated vision at the 8th week of gestation. She had no history of central nervous system infection or trauma. A brain magnetic resonance imaging was obtained. There was hydrocephalus due to cerebral aqueduct stenosis (Evan's index of 58%). She was managed conservatively with bed rest and diuretics; however, she got no relief. A ventriculoperitoneal shunt was inserted at the 13th week of gestation. At the 38th week, she had cesarean section (C/S) due to previous history of C/S in the first pregnancy and present cord entanglement of the fetus. C/S was conducted under epidural anesthesia after conforming she had no increased intra cranial pressure findings. Delivery was uneventful with a healthy newborn. Obstructive hydrocephalus is a very rare complication during pregnancy. Hydrocephalus becomes obvious and necessitates treatment, before the third trimester of pregnancy. Timely diagnosis, especially differentiation from preeclampsia, is a life-saving step. If no complication happens during intervention for hydrocephalus, spontaneous vaginal delivery is a safe way of delivery for both mother's and newborn's well-being. C/S should be saved for obstetrical indications and can be conducted under epidural anesthesia if intracranial pressure is kept under control. Interdisciplinary approach of neurosurgeons and anesthesiologists is pivotal for delicate care of the patient and the baby.

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