ABSTRACT
There are several reports of obstetric emergencies in pregnant patients with malignant intracranial tumors precipitated by worsening of the mother's neurological status which necessitate an early delivery of the fetus before definite therapy can be administered to the mother[1-3]. We describe a patient with a sphenoid sinus tumor who developed loss of vision due to rapid tumor progression necessitating an early delivery of her twin fetuses by cesarean section. The patient had co morbidities and requested to be awake during the surgery, she was managed using a combined spinal epidural anesthesia. The advantages of combined spinal epidural anesthesia as compared to a single shot subarachnoid block, epidural block or general anesthesia are discussed in a pregnant patient with decrease in intracranial compliance