Introduction: Neurofibromatosis is a rare inherited autosomal dominantdisorder characterized by multiple benign tumours and spots of increased skin pigmentation. The commonest member of the group is neurofibromatosis Type-1. An estimated 5% of patients with NF1 have an intra-oral manifestation of the disease. Case Report: A 6o-year-old female patient, with neurofibromatosis Type 1 was diagnosed with normal pressure hydrocephalus. She had diffuse dermal neurofibromas, peripheral IV line access proved impossible and central venous catheter in the right subclavian vein. She also had history of previous surgery for attempted V-P shunt which was postponed due to increased scalp bleed in which tracheal narrowing was noted with co-existing cervical spondylosis and altered neck anatomy as predictors for airway difficulty. Successful intubation by flexible fiber-optic was carried out without any airway block and the surgery concluded without any difficulties. Conclusion: Flexible fiber-optic laryngoscopy is a well-established and versatile tool for managing patients with known or suspected difficult airway and Neurofibromatosis is a rare pathology in surgical centres, which requires anesthetist to know its peculiarities and give special focus.