Peri-operative Management of Esthesioneuroblastoma Mimicking Pre-eclampsia in a 31-week Parturient: A Multi-disciplinary Anaesthetic Challenge

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BSTRACT

Neurological symptoms during pregnancy are commonly attributed to hypertensive disorders such as pre-eclampsia; however, intracranial pathologies may present similarly and delay diagnosis. We report the peri-operative management of a pregnant patient with esthesioneuroblastoma initially treated as pre-eclampsia. A 27-year-old parturient at 31 weeks of gestation presented with headache, seizure, altered sensorium and epistaxis. Initial management was directed toward pre-eclampsia, but neuro-imaging revealed an intracranial space-occupying lesion extending into the nasal cavity. A multi-disciplinary team performed an emergency caesarean section followed by bifrontal craniotomy, tumour excision, anterior skull base repair and endoscopic nasal debridement. Anaesthetic management aimed to maintain maternal haemodynamic stability, optimise cerebral perfusion and ensure foetal safety while managing significant blood loss. Post-operative recovery was gradual, and the patient was successfully extubated with an improving neurological status. This case highlights the importance of considering intracranial pathology in atypical neurological presentations in pregnancy and emphasises the role of coordinated multi-disciplinary peri-operative management.