Anesthetic Management in A Patient with Untreated Type L Neurofibromatosis and Left Tibial Fracture: A Clinical Case Report

Abstract

Neurofibromatosis type I (NF1) is a multisystemic genetic disorder that poses significant anesthetic challenges, particularly in undiagnosed patients and emergency settings¹.This report presents the case of a male patient with cognitive disability and no prior surgical or formal NF1 diagnosis, admitted due to a distal tibial fracture ². During the preoperative evaluation, clinical signs suggestive of NF1—such as café-au-lait spots, dermal neurofibromas, and Lisch nodules—were identified and confirmed by Internal Medicine³. Given a potentially difficult airway (Mallampati III, IPID 8), spinal anesthesia was chosen, using ropivacaine and fentanyl. The procedure was successful, with no hemodynamic or neurological complications ⁴.

This case highlights the importance of thorough preoperative assessment and individualized anesthetic planning based on patient-specific risks ⁵. It also highlights the safety of neuraxial approaches in NF1 patients when no structural contraindications are evident. This experience contributes to the medical literature by documenting a safe and effective alternative in scenarios with diagnostic uncertainty and elevated anesthetic risk.