Anesthetic Management of a Parturient With Lipomyelomeningocele and Tethered Cord for Cesarean Section.

Lipomyelomeningocele (LMMC) presents significant anesthetic challenges due to spinal cord tethering and distorted anatomy, which make the gold-standard neuraxial anesthesia technically difficult and neurologically risky. We report the case of a 29-year-old primigravida with LMMC and prior neurosurgeries scheduled for an elective cesarean section. Given the risk of direct neural injury and unpredictable block spread, a planned general anesthesia (GA) was performed, and a multimodal analgesic strategy was employed. The procedure was uneventful, resulting in a healthy neonate and a mother with excellent pain control and no deviation from her neurological baseline. This case demonstrates that while neuraxial techniques are usually preferred, GA is a safe and necessary alternative for patients with complex spinal dysraphism. Success requires a thorough preoperative neurological assessment, neuroimaging review, and tailored multidisciplinary approach.