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Choudhary D, Mohan V, Varsha AS, Hegde A, Menon G. Neurosurgical emergencies during pregnancy - Management dilemmas. Surg Neurol Int 2023; 14:151. [PMID: 37151438 PMCID: PMC10159311 DOI: 10.25259/sni_1076_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Background Neurosurgical emergencies in the obstetric setting pose considerable challenges. Decision-making involves deliberations on the gestational age, critical nature of the illness, timing of surgery, maternal positioning during neurosurgery, anesthesiologic strategies, monitoring of the pregnancy during surgery, and the mode of delivery. The present study discusses the management and ethical dilemmas encountered during the management of six obstetric patients with neurosurgical emergencies. Methods A retrospective review of all neurosurgical operations performed between January 2016 and December 2022 were included in the study. Results This study includes a series of six pregnant women who presented with neurosurgical emergencies, secondary to freshly diagnosed pathologies in the period 2016-2022. The mean maternal age was 31.33 years. Four of the six patients were in the third semester and two were in the second trimester. The underlying etiologies were as follows: spontaneous intracerebral hypertensive hemorrhage (1), obstructive hydrocephalus due to shunt malfunction (1), brain tumor (02), and compressive spinal cord myelopathy due to tumors (02). Three patients who were near term underwent lower cesarean section followed by emergency neurosurgical procedure in the same sitting. Two second trimester patients continued their pregnancy after the emergency neurosurgical operation. In one patient, in whom a brain tumor was diagnosed near term, underwent neurosurgery 1 week after successful cesarean section. All the six mothers and fetus recovered well, ex3cept two patients who have persisting residual deficits. Conclusion Treatment of neurosurgical emergencies during pregnancy needs to be customized depending on the clinical condition of the pregnant woman, prognosis of the disease, gestational age and the status of the pregnancy. With careful planning, timely intervention, consultative decision making and it is possible to achieve the ultimate goal - which is to protect and safeguard the mother and preserve and deliver a viable fetus.
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Affiliation(s)
| | | | | | | | - Girish Menon
- Corresponding author: Girish Menon, Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India.
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Carbone L, Somma T, Iorio GG, Vitulli F, Conforti A, Raffone A, Bove I, Pagano S, Pontillo M, Carbone IF, Farina A, Maruotti GM, Maiuri F, Cappabianca P, Alviggi C. Meningioma during pregnancy: what can influence the management? A case series and review of the literature. J Matern Fetal Neonatal Med 2021; 35:8767-8777. [PMID: 34822317 DOI: 10.1080/14767058.2021.2004585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose: Meningioma is a benign tumor, more frequent in female population. During pregnancy, distinguishing a meningioma from other common conditions presenting with similar symptoms (headache, vomiting, visual impairment) is challenging. Moreover, the management must consider not only maternal but also fetal health. The rarity of the condition does not allow to define the features to which look in order to stratify the risk for the need of surgery during pregnancy. We reported three cases of meningioma in pregnant women treated at our department and reviewed those previously reported in the literature. The aim of this review is to evaluate which factors are more determinant in such management.Methods: Electronic databases were searched from year 2000 until June 2020, to identify clinical studies on management of meningioma diagnosed during pregnancy. The primary outcome was surgical timing. Secondary outcomes were delivery methods, maternal and neonatal outcomes.Results: Surgery after pregnancy is more frequently performed in PR + tumor (p-value 0.038) and with HA (p-value 0.0445), as well as in meningioma diagnosed during the third trimester, compared to those diagnosed before (p-value 0.0012). Surgery during pregnancy was more frequent in patients with visual loss (p-value 0.006). No significant differences were found in surgical management, according to age, WHO grade, tumor location, lesion diameter and ER positivity. Delivery method is independent from both hormonal receptor status and main symptoms, but women who had neurosurgery during pregnancy delivered more frequently with spontaneous vaginal delivery (p-value <0.01).Conclusion: The decision regarding surgical timing of meningioma diagnosed during pregnancy depends on PR + and impending symptoms as visual loss or headache. It seems that timing of neurosurgery does not affect the delivery method. A multidisciplinary approach is always useful to perform a rapid and appropriate diagnosis and to better evaluate pros and cons of surgery during pregnancy and following management both for maternal and fetal wellness.
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Affiliation(s)
- Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Teresa Somma
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Giuseppe Gabriele Iorio
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Francesca Vitulli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Antonio Raffone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Ilaria Bove
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Serena Pagano
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Martina Pontillo
- Department of Public Health, School of Medicine, Federico II University, Naples, Italy
| | - Ilma Floriana Carbone
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Farina
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Francesco Maiuri
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Paolo Cappabianca
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
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Batchinsky-Parrou V, Barraud S, Kleiber JC, Litre F. First case of cyproterone acetate induced multiple meningiomas in identical female twins: A case report. Neurochirurgie 2021; 68:323-326. [PMID: 33989640 DOI: 10.1016/j.neuchi.2021.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/29/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
Meningiomas are the most common tumors of the central nervous system. Most meningiomas are benign and occur mainly in middle-aged women. Only a few cases of meningiomas in identical twins have been reported. Cyproterone acetate (Androcur® Bayer Healthcare SAS) (CPA) is an antiandrogenic progestin used to treat female hirsutism in some countries including France. We report a case of identical twin sisters who developed multiple, atypically located meningiomas in the setting of long-term CPA use. Eighteen-month follow-up showed spontaneous decrease of meningiomas after cessation of CPA. This case illustrates CPA's ability to induce development of atypically located meningiomas that differ even between identical twins, confirms benefit of surgical abstention, and raises questions regarding security of use of CPA.
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Affiliation(s)
- V Batchinsky-Parrou
- Neurosurgery University Hospital Reims, 45, rue de Cognacq Jay, 51092 Reims, France.
| | - S Barraud
- Endocrinology University Hospital Reims, Reims, France
| | - J C Kleiber
- Neurosurgery University Hospital Reims, 45, rue de Cognacq Jay, 51092 Reims, France
| | - F Litre
- Neurosurgery University Hospital Reims, 45, rue de Cognacq Jay, 51092 Reims, France
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Zoli M, Guaraldi F, Zoia C, La Corte E, Asioli S, Bongetta D, Rustici A, Mazzatenta D. Management of sellar and parasellar tumors becoming symptomatic during pregnancy: a practical algorithm based on multi-center experience and systematic literature review. Pituitary 2021; 24:269-283. [PMID: 33200305 PMCID: PMC7966198 DOI: 10.1007/s11102-020-01107-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Sellar/parasellar tumors (SPTs) very rarely become symptomatic during pregnancy. No specific guidelines exist for their management, that is extremely challenging as mother and fetus health can be jeopardized. MATERIALS AND METHODS Data of patients with SPTs becoming symptomatic during pregnancy treated at two Italian referral Centers were retrospectively collected. Systematic literature review was also performed. RESULTS Our series consisted of 6 cases, 3 meningiomas, 1 ACTH-secreting adenoma, 1 pituicytoma and 1 craniopharyngioma. Mean age at presentation was 33.6 ± 6.0 years. Five patients complained of visual disturbances, associated with headache in one case, that occurred between gestation week (GW) 22 and 34. In 5 cases, pregnancy was uneventful with the delivery of a healthy baby between GW 33 and 35, followed by endoscopic surgical tumor exeresis (n = 4) or proton bean therapy (n = 1). Another patient presented with stigmata typical of Cushing's syndrome and rapidly worsening pre-eclampsia, that required pregnancy interruption and adenomectomy. Based on personal and literature cases, a practical algorithm was proposed to help clinicians dealing with these patients. CONCLUSIONS SPTs becoming symptomatic in pregnancy deserve careful monitoring and multidisciplinary management. Overall, wait-and-see approach is suggested, reserving surgery to patients with rapidly progressive/life-threatening situations, significant risk of permanent neurological impairment or malignant lesions.
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Affiliation(s)
- Matteo Zoli
- Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
| | - Federica Guaraldi
- Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuele La Corte
- Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Unit of Anatomic Pathology 'M. Malpighi', Bellaria Hospital, Azienda USL Bologna, Bologna, Italy
| | | | - Arianna Rustici
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Tuberculum Sellae Meningiomas in Pregnancy: 3 Cases Treated in the Second Trimester and Literature Review. World Neurosurg 2020; 143:268-275. [PMID: 32758650 DOI: 10.1016/j.wneu.2020.07.198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tuberculum sella meningiomas typically present with progressive visual loss. It is also known that meningiomas can become symptomatic during pregnancy. Herein we report on 3 patients who presented with progressive visual decline during pregnancy, prompting urgent surgical removal of their meningiomas. CASE DESCRIPTIONS From our prospectively collected brain tumor database, all women surgically treated for tuberculum sella meningioma since 2006 were retrospectively reviewed. Clinical presentation, surgical approach, perioperative management, and pathology of pregnant patients were reviewed and compared with those of the nonpregnant cohort. Of 43 women with newly diagnosed tuberculum sella meningioma, 3 (7%) presented in pregnancy with progressive visual loss, 1 in the late first trimester and 2 in the early second trimester. One woman pregnant with twins had a broad-based meningioma and underwent a supraorbital craniotomy and gross total tumor removal in her second trimester. Two women with singleton pregnancies both underwent endoscopic endonasal gross total tumor removal during their second trimesters. All 3 patients had visual recovery, 2 of which were complete, and all went on to have successful uncomplicated deliveries of their children and maintain normal pituitary gland function. CONCLUSIONS Presentation of tuberculum sella meningioma during pregnancy is uncommon but not rare, accounting for 7% of women in our series. Ideally, surgery is performed in the second trimester, ensuring fetal safety while restoring maternal vision and maintaining pituitary gland function are essential. Depending on tumor size and sellar anatomy, endoscopic endonasal or supraorbital keyhole craniotomy approaches are both viable options.
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Graillon T, Cuny T, Castinetti F, Courbière B, Cousin M, Albarel F, Morange I, Bruder N, Brue T, Dufour H. Surgical indications for pituitary tumors during pregnancy: a literature review. Pituitary 2020; 23:189-199. [PMID: 31691893 DOI: 10.1007/s11102-019-01004-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Surgical indications for pituitary tumors during pregnancy are rare, and are derived from a balance between expected benefits, particularly for maternal benefits, and anesthetic/surgical risks. METHODS A literature review was performed to define the optimal surgical indications for pituitary adenomas (PA) and other pituitary tumors during pregnancy. RESULTS Main benefits are expected in case of critical visual impairment and/or life-threatening endocrine disturbances. Multidisciplinary patient management is systematically required although nonobstetric surgery presents a reasonable risk during pregnancy. The risks of congenital malformation during the first trimester and those of premature birth during the third trimester make the second trimester the optimal period for surgery. In prolactin-secreting, nonsecreting, GH- and TSH-secreting PAs, transsphenoidal surgery (TS) is recommended in cases involving severe visual impairment, characterized by severe visual field deficit, visual acuity impairment, and abnormal optical coherence tomography findings, and when no other medical alternatives are possible and/or sufficient. Uncontrolled and severe Cushing's disease (CD) during pregnancy increases both maternal and fetal morbimortality, thus justifying TS or sometimes dopamine agonist therapy as a safer alternative. Finally, metyrapone, ketoconazole, or bilateral adrenalectomy could be recommended in certain cases after the failure of medical therapies and/or TS. Surgery is also required for suprasellar meningiomas, craniopharyngiomas, and pituitary cysts in the case of severe visual deficit. CONCLUSION Surgical indications for pituitary tumors are rare during pregnancy; therefore, surgery should be avoided when possible. Further, the second trimester should be considered as the optimal surgical period. Severe visual disturbance and uncontrolled CD are the main surgical indications during pregnancy.
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Affiliation(s)
- Thomas Graillon
- Neurosurgery Department, Aix-Marseille Univ, APHM, CHU Timone, La Timone Hospital, 264 rue Saint-Pierre, 13005, Marseille, France.
- Aix-Marseille Univ, INSERM, MMG, Marseille, France.
| | - Thomas Cuny
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Frédéric Castinetti
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Blandine Courbière
- Centre Clinico-Biologique d'AMP, Pôle Femmes-Parents-Enfants, Hôpital de La Conception, AP-HM, Marseille/Aix Marseille Univ, Avignon Univ, CNRS, IRD, IBME, Marseille, France
| | - Marie Cousin
- Cabinet d'Ophtalmologie, Saint-Rémy de Provence, France
| | - Frédérique Albarel
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Isabelle Morange
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Nicolas Bruder
- Anesthesiology-Intensive Care Department, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France
| | - Thierry Brue
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Henry Dufour
- Neurosurgery Department, Aix-Marseille Univ, APHM, CHU Timone, La Timone Hospital, 264 rue Saint-Pierre, 13005, Marseille, France
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
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7
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Zhong HP, Tang H, Zhang Y, Luo Y, Yao H, Cheng Y, Gu WT, Wei YX, Wu ZB. Multidisciplinary team efforts improve the surgical outcomes of sellar region lesions during pregnancy. Endocrine 2019; 66:477-484. [PMID: 31422527 DOI: 10.1007/s12020-019-02054-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Treatment of space-occupying lesions (SOLs) in the sellar region is a clinical challenge, especially in pregnant women because many treatment decisions are restrained due to pregnancy. We attempt to discuss the surgical indications and timing for pregnant patients and highlight the importance of multidisciplinary team (MDT) treatment. METHODS From August 2017 to February 2018, four pregnant women were admitted to our hospital with severe visual impairment due to sellar region SOLs, including two cases of tuberculum sellae meningioma, one case of giant pituitary adenoma and one case of a pituitary abscess. All four patients were safely treated by surgery during the second and third trimesters of pregnancy through concerted efforts of the MDT, including a neurosurgeon as the team leader in combination with experts in obstetrics, ophthalmology and endocrinology. RESULTS The SOLs were removed completely from all four patients, resulting in significantly improved vision without operation-related complications. Pregnancy continued postoperatively to full-term delivery in three of the four patients. The other patient with a pituitary abscess selected to terminate the pregnancy at a gestational age of 20 weeks because of her own concerns. The four babies (including a pair of twins) were born healthy and had developed normally at the 6-week postpartum follow-up. CONCLUSIONS With the MDT guiding the decision-making process, surgical resection of sellar region SOLs in pregnant women with severe visual impairment is practical to improve the prognosis without affecting the outcomes of pregnancy for either the mother or the infant.
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Affiliation(s)
- Hui Ping Zhong
- Department of Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Tang
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Zhang
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Luo
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Yao
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Cheng
- Department of Ophthalmology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Ting Gu
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Xu Wei
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhe Bao Wu
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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8
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Suction Filter in Endoscopic Endonasal Surgery: A Technical Note. World Neurosurg 2016; 95:464-468. [PMID: 27544339 DOI: 10.1016/j.wneu.2016.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The collection of the greatest possible amount of pathologic tissue is of paramount importance in neurosurgery to achieve the most accurate histopathologic diagnosis, to perform all of the necessary biomolecular tests on the pathologic specimen, and to collect biological material for basic or translational science studies. This problem is particularly relevant in pituitary surgery because of the possible small size and soft consistency of tumors, which make them suitable for removal through suction, reducing the amount of available pathologic tissue. To solve this issue, we adopted a filter connected to the suction tube, which allows the surgeon to collect all of the tissue aspirated during surgery. METHODS Our experience of 1734 endoscopic endonasal procedures, performed adopting this device since 1998 to December 2015, has been revised to assess its advantages and limitations. RESULTS This system is easy-to-use, does not impair the surgical maneuvers, and does not add any relevant cost to the surgery. The tissue collected through the filter proved useful for diagnostic histologic and biomolecular analyses and for research purposes, without any relevant artifacts as a result of this method of collection. CONCLUSIONS The use of a filter has allowed us to obtain the greatest amount possible of pathologic tissue at each surgery. This surgical material has revealed to be helpful both for diagnostic and basic science purposes. The use of the filter has proven to be of particular importance for microadenomas, soft tumors, and supradiaphragmatic or skull base lesions with heterogeneous features, improving the accuracy of histopathologic diagnosis.
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Casas Parera I, Báez A, Banfi N, Blumenkrantz Y, Halfon MJ, Barros M, Campero Á, Larrarte G, De Robles P, Rostagno R, Gonzalez Roffo A, Campanucci V, Igirio Gamero JL, Figueroa Intriago WL, Díaz Granados S, Martínez Tamborini N, Kuchkaryan VB, Lozano C. Meningiomas en neurooncología. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.neuarg.2016.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Moscovici S, Fraifeld S, Cohen JE, Dotan S, Elchalal U, Shoshan Y, Spektor S. Parasellar Meningiomas in Pregnancy: Surgical Results and Visual Outcomes. World Neurosurg 2014; 82:e503-12. [DOI: 10.1016/j.wneu.2013.06.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 02/27/2013] [Accepted: 06/29/2013] [Indexed: 11/25/2022]
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11
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Spinal meningioma becoming symptomatic in the third trimester of pregnancy. J Clin Neurosci 2013; 20:1797-9. [DOI: 10.1016/j.jocn.2013.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 08/07/2013] [Indexed: 11/23/2022]
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12
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Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic skull base surgery: a comprehensive comparison with open transcranial approaches. Br J Neurosurg 2012; 26:637-48. [PMID: 22324437 DOI: 10.3109/02688697.2012.654837] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Little data exists comparing endoscopic endonasal approaches to pathology of the anterior skull base with more traditional transcranial and transsphenoidal microscopic approaches. In order to more fully characterize the role of endoscopy in the management of pathology of the anterior cranial base, we conducted a systematic review of case series and case reports documenting surgical and clinical outcomes. We found that for craniopharyngiomas, clival chordomas, esthesioneuroblastomas and giant pituitary adenomas, the endonasal endoscopic approach can result in equivalent or higher rates of gross total resection than open approaches. For meningiomas, however, open transcranial approaches are still able to achieve higher rates of total resection. CSF leak rates are higher for patients undergoing endoscopic surgery for meningiomas and craniopharyngiomas, but not for chordomas, esthesioneuroblastomas or giant pituitary adenomas. In certain patients, the endonasal endoscopic approach may be a safe and effective alternative for the treatment of a wide variety of skull base pathology, particularly those with small midline tumours.
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Affiliation(s)
- Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
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13
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Gruber TJ, Fabiano AJ, Deeb G, Lele SB, Fenstermaker RA. Intracranial meningiomas in patients with uterine sarcoma treated with long-term megestrol acetate therapy. World Neurosurg 2012; 76:477.e16-20. [PMID: 22152580 DOI: 10.1016/j.wneu.2011.03.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 03/03/2011] [Accepted: 03/25/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report a series of four patients with uterine sarcoma, including one with müllerian adenosarcoma (MA) and three with low-grade endometrial stromal sarcoma (LGESS), who developed intracranial meningiomas while receiving the progesterone agonist megestrol acetate. METHODS The hospital records, imaging studies, and pathology slides of four patients who were treated for uterine sarcomas and subsequently developed intracranial meningiomas were reviewed. RESULTS All patients underwent surgery for their gynecologic cancers and received maintenance therapy with long-term hormonal suppression with megestrol acetate. Each of the four patients later developed neurologic symptoms secondary to intracranial meningiomas. Three patients had more than one meningioma. Histopathologic examination of all excised tumors showed strong immunoreactivity for progesterone receptors (PRs). CONCLUSIONS Patients with uterine sarcoma subtypes LGESS and MA may be predisposed to develop meningiomas, particularly in the setting of long-term treatment with megestrol acetate. Alternatively, preexisting, clinically silent meningiomas in these patients may have progressed to the point of clinical symptoms in the presence of the progesterone agonist megestrol acetate. Without previous imaging studies showing the presence or absence of meningioma before initiation of megestrol acetate treatment, there is no way to draw definitive conclusions regarding this possibility. Clinical and neuroradiologic surveillance for meningiomas should be strongly considered in patients with these uterine sarcoma subtypes, particularly in patients undergoing long-term suppressive therapy with megestrol acetate.
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Affiliation(s)
- Thomas J Gruber
- Department of Neurosurgery, Roswell Park Cancer Institute and School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
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SHITARA S, NITTA N, FUKAMI T, NOZAKI K. Tuberculum Sellae Meningioma Causing Progressive Visual Impairment During Pregnancy. Neurol Med Chir (Tokyo) 2012; 52:607-11. [DOI: 10.2176/nmc.52.607] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Satoshi SHITARA
- Department of Neurosurgery, Shiga University of Medical Science
| | - Naoki NITTA
- Department of Neurosurgery, Shiga University of Medical Science
| | - Tadateru FUKAMI
- Department of Neurosurgery, Shiga University of Medical Science
| | - Kazuhiko NOZAKI
- Department of Neurosurgery, Shiga University of Medical Science
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Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas. World Neurosurg 2011; 77:713-24. [PMID: 22120296 DOI: 10.1016/j.wneu.2011.08.025] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 05/26/2011] [Accepted: 08/16/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To assess the advantages and limitations of the endoscopic endonasal approach to anterior skull base meningiomas, a minimally invasive approach that avoids extensive bone drilling, brain retraction, and manipulation of nerves and critical vessels, versus open transcranial surgery. METHODS A MEDLINE (2000-2010) search was performed to identify series for either olfactory groove meningiomas or tuberculum sellae (TS) or planum sphenoidale meningiomas. Statistical analyses of categorical variables such as extent of resection, morbidity, and visual outcome were performed using χ(2) and Fisher exact tests. RESULTS The literature review included 60 studies, involving 1426 patients. Open surgery achieved a higher rate of gross total resection (GTR) for both olfactory groove (P < 0.001) and TS and planum (P < 0.001) meningiomas. Postoperative cerebrospinal fluid (CSF) leak occurred more frequently in the endoscopic cohort (P < 0.001). Other postoperative complications occurred more frequently in the open cohort, although this difference was not statistically significant. There were no significant differences in postoperative visual outcome between the groups. CONCLUSIONS Based on the current literature, open transcranial approaches for olfactory groove and TS and planum sphenoidale meningiomas still result in higher rates of total resection with lower postoperative CSF leak rates. The endoscopic endonasal approach may be safe and effective for certain skull base meningiomas; careful patient selection and multilayer closure techniques are essential.
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Affiliation(s)
- Ricardo J Komotar
- Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Kasper EM, Hess PE, Silasi M, Lim KH, Gray J, Reddy H, Gilmore L, Kasper B. A pregnant female with a large intracranial mass: Reviewing the evidence to obtain management guidelines for intracranial meningiomas during pregnancy. Surg Neurol Int 2010; 1:95. [PMID: 21245945 PMCID: PMC3019368 DOI: 10.4103/2152-7806.74242] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 10/31/2010] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Non-obstetric surgery for intracranial meningioma is uncommon during pregnancy and poses significant risks to both the mother and the fetus. We present a case of a parturient that presented with acute mental status changes and we illustrate the decision making process that resulted in a best-possible outcome. CASE DESCRIPTION A woman at 29-week gestation presented with acute language and speech deficits and deteriorating mental status after 2 weeks of headache. Imaging demonstrated a large intracranial mass. A multidisciplinary meeting was held to determine the best treatment plan. The decision was to proceed with caesarean delivery under epidural anesthesia to allow intraoperative monitoring of neurological function. Six hours after successful delivery, the patient had acute mental status changes and she was taken to the operating room immediately for resection of her tumor, which turned out to be a clear cell meningioma. DISCUSSION Cerebral meningioma is usually a slow-growing tumor; however, during pregnancy, the mass may expand rapidly due to hormonal receptor expression. The presentation of this patient would have normally led to urgent resection of the mass. But the complicating factor was her 29-week pregnancy as standard intraoperative treatment during neurosurgery is known to adversely affect the fetus. A multidisciplinary meeting was critical for this patient's care, and is recommended by us when treating such patients.
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Affiliation(s)
- Ekkehard M Kasper
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, One Deaconness Road, Boston, MA 02215, USA
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Cebula H, Pham TQ, Boyer P, Froelich S. Regression of meningiomas after discontinuation of cyproterone acetate in a transsexual patient. Acta Neurochir (Wien) 2010; 152:1955-6. [PMID: 20811919 DOI: 10.1007/s00701-010-0787-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
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Spontaneous Postpartum Resolution of Vision Loss Caused by a Progesterone Receptor-Positive Tuberculum Sellae Meningioma. J Neuroophthalmol 2010; 30:132-4. [DOI: 10.1097/wno.0b013e3181da9d59] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gutenberg A, Landek-Salgado M, Tzou SC, Lupi I, Geis A, Kimura H, Caturegli P. Autoimmune hypophysitis: expanding the differential diagnosis to CTLA-4 blockade. Expert Rev Endocrinol Metab 2009; 4:681-698. [PMID: 30780785 DOI: 10.1586/eem.09.37] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Autoimmune hypophysitis is an increasingly recognized disorder that enters in the differential diagnosis of nonfunctioning pituitary masses. The differential diagnosis of these conditions is challenging because of similar clinical presentations and radiological signs. This review describes the essential features of hypophysitis and the other nonfunctioning pituitary masses. It also emphasizes a recently described feature of hypophysitis: its appearance with unexpectedly high frequency in patients receiving treatments that abrogate the function of cytotoxic T lymphocyte antigen 4.
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Affiliation(s)
- Angelika Gutenberg
- a Department of Neurosurgery, Georg-August University, Goettingen, Germany.
| | - Melissa Landek-Salgado
- b Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Shey-Cherng Tzou
- c Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Isabella Lupi
- d Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy.
| | - Abby Geis
- e Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Hiroaki Kimura
- f Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Patrizio Caturegli
- g Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Walsh MT, Couldwell WT. Management options for cavernous sinus meningiomas. J Neurooncol 2009; 92:307-16. [DOI: 10.1007/s11060-009-9824-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 02/23/2009] [Indexed: 02/04/2023]
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