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

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.