Authors :
Ajit Kumar; Tanzim Akram; Mohammad Azhar Khan; Abhisek Dey; Bogala Divyalakshmi
Volume/Issue :
Volume 11 - 2026, Issue 9 - September
Google Scholar :
https://tinyurl.com/2mzcxxmj
DOI :
https://doi.org/10.38124/ijisrt/26sep519
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Abstract :
Giant neurofibromas of the back are uncommon and present unique perioperative challenges, particularly for airway
management and intraoperative positioning. We report a case of a giant neurofibroma extending from the C6 to L3 vertebral level,
weighing 9 kg after excision, in a 51-year-old male patient. The posterior location and size of the mass made positioning for
laryngoscopy and intubation difficult. After successful intubation, the patient was placed prone, but the mass effect of the
neurofibroma caused the head to deviate laterally, making it difficult to maintain a neutral position; this was overcome by stabilising
the head with adhesive strapping (Dynaplast). Excision was associated with significant blood loss of approximately 2500 mL, which
was managed with 3000 mL of crystalloid, 3 units of packed red blood cells and 3 units of fresh frozen plasma, with stable
haemodynamic throughout. This report highlights the airway, positioning and haemodynamic considerations in the anaesthetic
management of giant posterior neurofibromas and describes a simple, improvised solution for intraoperative head stabilisation.
Keywords :
Neurofibroma; Neurofibromatosis Type 1; Giant Neurofibroma; Anaesthetic Management; Airway Management; Prone Positioning.
References :
- Hirsch NP, Murphy A, Radcliffe JJ. Neurofibromatosis: clinical presentations and anaesthetic implications. Br J Anaesth. 2001;86(4):555-64.
- Mendonça FT, de Moura IB, Pellizzaro D, Grossi BJ, Carvalho Diniz R. Anesthetic management in patient with neurofibromatosis: a case report and literature review. Acta Anaesthesiol Belg. 2016;67(1):48-52.
- Nahabedian MY, Rozen SM, Namnoum JD, Vander Kolk CA. Giant plexiform neurofibroma of the back. Ann Plast Surg. 2000;45(4):442-5.
- Vélez R, Barrera-Ochoa S, Barastegui D, Pérez-Lafuente M, Romagosa C, Pérez M, et al. Multidisciplinary management of a giant plexiform neurofibroma by double sequential preoperative embolization and surgical resection. Case Rep Neurol Med. 2013;2013:987623.
Giant neurofibromas of the back are uncommon and present unique perioperative challenges, particularly for airway
management and intraoperative positioning. We report a case of a giant neurofibroma extending from the C6 to L3 vertebral level,
weighing 9 kg after excision, in a 51-year-old male patient. The posterior location and size of the mass made positioning for
laryngoscopy and intubation difficult. After successful intubation, the patient was placed prone, but the mass effect of the
neurofibroma caused the head to deviate laterally, making it difficult to maintain a neutral position; this was overcome by stabilising
the head with adhesive strapping (Dynaplast). Excision was associated with significant blood loss of approximately 2500 mL, which
was managed with 3000 mL of crystalloid, 3 units of packed red blood cells and 3 units of fresh frozen plasma, with stable
haemodynamic throughout. This report highlights the airway, positioning and haemodynamic considerations in the anaesthetic
management of giant posterior neurofibromas and describes a simple, improvised solution for intraoperative head stabilisation.
Keywords :
Neurofibroma; Neurofibromatosis Type 1; Giant Neurofibroma; Anaesthetic Management; Airway Management; Prone Positioning.
