A primaparous woman in her 35th week of pregnancy, presented to hospital with a three-week history of headache, unsteadiness and nausea. Her relevant history included triple negative breast cancer, treated three years previously with surgical resection and neoadjuvant chemoradiotherapy. Imaging revealed a cerebellar vermis lesion with acute obstructive hydrocephalus, likely to be metastatic disease. She was also found to have thrombi in her brachiocephalic and internal jugular veins.

She commenced dexamethasone, was transferred to the neurosurgical centre and started split dose anticoagulation. Over the following week, she underwent imaging, daily neurosurgical and regular obstetric, midwifery and anaesthetic review.

Despite steroids, her neurological symptoms progressed, necessitating emergent decompression. Following multidisciplinary planning, her anticoagulation was paused enabling a category 3 caesarean section under general anaesthesia, immediately followed by insertion of an external ventricular drain (EVD).

She had a straightforward caesarean section with minimal blood loss and delivery of a healthy infant. Following this, she underwent successful drainage of her hydrocephalus, facilitating extubation at the end of surgery.

After the initial surgery, arrangements were made for her to spend time with her baby and partner on the neurosurgical ward with regular involvement from the obstetric and midwifery teams, as well as her neurosurgical team.