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Neurofibromatosis type I is a genetic autosomal dominant disorder with multisystem involvement and is particularly challenging for the anesthesiologist in emergency surgery. The presence of neurofibromas can cause airway difficulty, make delivery of gases difficult, and blood pressure variations during general anesthesia. Regional anesthesia becomes challenging due to the presence of spinal and intracranial tumors, and in undiagnosed situations, it becomes tricky. This is a case report of anesthesia management in a pregnant patient with undiagnosed neurofibromatosis for an emergency cesarean section.

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Giant Tarlov cysts are described as fluid-filled sacs located in the spine. They are mostly found in the sacral region, but are usually asymptomatic. The symptomatic Tarlov cysts are planned for surgical treatment in the form of laminectomy and marsupilisation of cysts. These surgical procedures can have complications like cerebrospinal fluid (CSF) leak, bacterial meningitis, and radiculopathic pain. We report a case of a 30year-old male who presented with complaints of pain in his left leg for one and half years, urinary incontinence off and on for six months, and scrotal pain for two months. He was diagnosed with two giant Tarlov cysts on contrast-enhanced magnetic resonance imaging and planned for surgery. Intraoperatively, approximately 1000 ml of CSF was drained. The patient complained of severe headache in the immediate postoperative period, which was confirmed to be a low-CSF pressure headache. Prompt diagnosis and management with collaborative teamwork of neuroanesthetists and neurosurgeons helped treat the patient and prevent long-term morbidity.

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