\u201cPlease mind the gap\u201d: successful use of ultrasound-assisted spinal anesthesia for urgent cesarean section in a patient with implanted spinal cord stimulation system for giant chest wall arteriovenous malformation \u2013 a case report

Bruno Antonio Zanfini,Gaetano Draisci,Salvatore De Martino,Pietro Paolo Giuri,Francesco Vitale Di Maio,Stefano Catarci,Gian Luigi Gonnella,Luciano Frassanito

doi:10.1186/s12871-020-01042-6

Bruno Antonio Zanfini, Gaetano Draisci + Show 6 more

Open Access

https://doi.org/10.1186/s12871-020-01042-6

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Abstract

BackgroundThe use of Spinal Cord Stimulation (SCS) system to treat medically refractory neuropathic pain is increasing. Severe neuropathic pain can be found in giant chest wall arteriovenous malformations (AVMs), exceedingly rare and debilitating abnormalities, rarely reported during pregnancy.Case presentationWe present a report of a pregnant patient with implanted Spinal Cord Stimulation (SCS) system because of painful thoracic AVM scheduled for an urgent cesarean section in which we used lumbar ultrasound (US) to rule out the possibility to damage SCS electrodes and to find a safe site to perform spinal anesthesia.ConclusionsThe use of lumbar US to find a safe site for a lumbar puncture in presence of SCS system in a patient affected by painful thoracic AVM makes this case a particularly unique operative challenge and offers a new possible use of ultrasound to detect a safe space in patients with SCS implant.

Highlights

The use of Spinal Cord Stimulation (SCS) system to treat medically refractory neuropathic pain is increasing
We report a case of a 29 years old pregnant patient with a giant, congenital, painful arteriovenous malformations (AVMs) of the left chest
An urgent cesarean section was planned because of the membrane rupture and the risk of severe bleeding due to a possible AVM rupture in case of vaginal birth, due to the increasing of thoracic pressure during pushing [7]

Summary

Introduction

Background The use of Spinal Cord Stimulation (SCS) system to treat medically refractory neuropathic pain is increasing [1]. Severe neuropathic pain can be found in giant chest wall arteriovenous malformations. Congenital chest wall AVMs are rare, with few case reports available in the literature [2,3,4,5,6], but extremely debilitating: if no treatment is performed thoracic AVMs can cause severe bleeding, cardiac failure associated with arteriovenous shunting and severe neuropathic thoracic pain.

Results

Conclusion