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Khoromi S. Secondary headaches in pregnancy and the puerperium. Front Neurol 2023; 14:1239078. [PMID: 37840942 PMCID: PMC10569305 DOI: 10.3389/fneur.2023.1239078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023] Open
Abstract
Headache during pregnancy can be due to primary causes such as migraine but can also be a presenting symptom of secondary causes including life threatening conditions. This is a minireview of secondary causes of headache during pregnancy and the puerperium. Unique alterations in physiological and vascular functions as well as in the coagulation pathway which occur during pregnancy increase the risk of most of these secondary conditions which include preeclampsia, eclampsia, hemorrhagic stroke, cerebral venous, sinus thrombosis, reversible cerebral vascular syndrome, and posterior reversible encephalopathy. Marked increase in progesterone level in pregnancy is also associated with the growth of tumors such as meningiomas, as 70% of these tumors are positive for progesterone receptors and increase in size can lead to headache along with other neurological symptoms. Hemodynamic changes can lead to the growth of meningiomas as well. Although hormone producing pituitary tumors are usually not conducing to pregnancy, women with known pituitary tumors who do get pregnant may become symptomatic during pregnancy and develop secondary headache. Another rare cause of secondary headache during pregnancy is pituitary apoplexy. Although its occurrence is uncommon, it needs to be properly recognized and treated to avoid endocrine and visual complications. Other rare entities with increased incidence during the puerperium such postdural puncture headache will be also discussed. In summary, new onset headache during pregnancy deserves special attention because in the absence of proper recognition and treatment, secondary headache disorders can endanger the life of the mother and the fetus.
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Affiliation(s)
- Suzan Khoromi
- University of California, San Diego, La Jolla, CA, United States
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Wu Y, Xue Y, Wang X, Li J, Qu Y, Zhao T. A pregnant woman with a giant bilateral parietal hemangiopericytoma underwent multiple surgeries and radiotherapy: a case report and literature review. Front Oncol 2023; 13:1172143. [PMID: 37554166 PMCID: PMC10405728 DOI: 10.3389/fonc.2023.1172143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023] Open
Abstract
Intracranial hemangiopericytoma is a rare invasive tumor originating from mesenchymal fibroblasts and is prone to local recurrence and distant metastasis. This study reports a case of a 27-year-old woman who presented with severe headache, nausea and vomiting for two weeks at thirty-three weeks of gestation. Cranial magnetic resonance imaging (MRI) demonstrated a giant lesion in the bilateral parietal lobe with a size of 5.12x9.19x6.03 cm and severe edema in the surrounding brain tissue. The patient underwent four operations and 3 gamma knife radiosurgery procedures and is recovering well now. The histopathology findings showed hemangiopericytoma and STAT6 and CD34 positivity after the first and second surgeries. Because of tumor progression, the patient received gamma knife radiosurgery at 1, 3, and 4 years after the first operation. Total tumor resection was achieved in the fourth surgery. Nevertheless, the patient showed malignant transformation to from low-grade to high-grade hemangiopericytoma.
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Affiliation(s)
- Yingxi Wu
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yafei Xue
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Xinqi Wang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Junting Li
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Tianzhi Zhao
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
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Ghimire P, Pang G, Philip J, Hazem S, Rajwani K, Lavrador JP, Grahovac G, Bleil C, Thomas N, Gullan R, Vergani F, Bhangoo R, Ashkan K. Therapeutic Strategies and Challenges in the Management of Craniospinal Tumors in Pregnancy: A Ten-Year Retrospective Tertiary-Center Study, Systematic Review, and Proposal of Treatment Algorithms. World Neurosurg 2023; 171:e213-e229. [PMID: 36481447 DOI: 10.1016/j.wneu.2022.11.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aims to review therapeutic strategies in the management of craniospinal tumors in pregnant patients and the factors that may influence the management along with their influence on maternal and fetal outcomes. METHODS A retrospective single-center cohort study was performed at a tertiary neurosurgical referral center. Pregnant patients referred to the neuro-oncology multidisciplinary meeting (MDM) with craniospinal tumor were included. Ten-year patient data were collected from hospital records and neuro-oncology MDM outcomes. A systematic review was performed of the available literature as per PRISMA guidelines. RESULTS Twenty-five patients were identified, with a mean age of 31 years. Of these patients, 88% (n = 22) had cranial lesions and 12% (n = 3) had spinal lesions. Most of the patients had World Health Organization grade I/II tumors. Of the patients, 44% underwent surgery when pregnant, whereas in 40%, this was deferred until after the due date. Of patients, 16% did not require surgical intervention and were followed up with serial imaging in the MDM. The left lateral/park bench position was the preferred position for the spinal and posterior fossa lesions. Systematic review and retrospective data led to proposal of treatment algorithms addressing the therapeutic strategy for management of craniospinal tumors during pregnancy. Factors that may influence maternal and fetal outcomes during management of these tumors were identified, including aggressiveness of the tumor and stage of pregnancy. CONCLUSIONS Craniospinal tumors presenting in pregnancy are challenging. The surgical management needs to be tailored individually and as part of a multidisciplinary team approach. Factors influencing maternal and fetal outcomes are to be considered during management and patient counseling.
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Affiliation(s)
- Prajwal Ghimire
- King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Graeme Pang
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jerry Philip
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Sally Hazem
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Kapil Rajwani
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Gordan Grahovac
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Cristina Bleil
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Nicholas Thomas
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Gullan
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Francesco Vergani
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ranjeev Bhangoo
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Keyoumars Ashkan
- King's College Hospital NHS Foundation Trust, London, United Kingdom; Kings College London, London, United Kingdom
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Somma T, Bove I, Vitulli F, Cappabianca P, Pessina F, Alviggi C, Santi L, Della Pepa GM, Sabatino G, Olivi A, Ius T. Management and treatment of brain tumors during pregnancy: an Italian survey. J Neurooncol 2023; 161:13-22. [PMID: 36580221 DOI: 10.1007/s11060-022-04215-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/13/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The management of brain tumors during pregnancy is challenging. The clinical rarity and prognostic heterogeneity of such condition makes it difficult to develop standardized guidelines of treatment. The aim of this study was to assess the treatment options used in pregnant women with brain tumors that are currently used in Italy, considering the management of these patients reported in current literature in this field. METHODS A survey addressing the treatments options and management of brain tumors during pregnancy was designed on behalf of an ad-hoc task-force Neuro-Oncology committee of the Società Italiana di Neurochirurgia (SINch) to analyze the management of pregnant patients with brain tumors. We conducted a search of the literature published between January 2011 and September 2021, using MEDLINE (PubMed) in accordance to PRISMA guidelines. Data were discussed to obtain recommendations after evaluation of the selected articles and discussion among the experts. RESULTS A total of 18 Neurosurgical centers participated in the survey. A total of 31 pregnant women were included in this retrospective study. Meningiomas and gliomas were the two most common types of brain tumors diagnosed during pregnancy. An emergency surgical procedure was required in 12.9% of cases. CONCLUSION A multidisciplinary and tailored approach is fundamental. In women showing clinical stability, neurosurgical options should preferably be delayed if possible, and considered during the second trimester or after delivery. In patients with acute neurological symptoms or tumor progression, medical abortion in the first trimester or a C-section in the second and third trimester need to be considered.
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Affiliation(s)
- Teresa Somma
- Division of Neurosurgery, Department of Neurological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Ilaria Bove
- Division of Neurosurgery, Department of Neurological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy.
| | - Francesca Vitulli
- Division of Neurosurgery, Department of Neurological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neurological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy
| | - Laura Santi
- Neurosurgical Unit of Sondrio ASST - Valtellina e alto Lario, Sondrio, Italy
| | - Giuseppe Maria Della Pepa
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100, Rome, Italy
| | | | - Alessandro Olivi
- Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | - Tamara Ius
- Neurosurgery Unit, Head-Neck and NeuroScience Department, University Hospital of Udine, Udine, Italy
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Burden of maternal and fetal outcomes among pregnant cancer survivors during delivery hospitalizations in the United States. Sci Rep 2022; 12:9989. [PMID: 35705610 PMCID: PMC9200828 DOI: 10.1038/s41598-022-13852-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/30/2022] [Indexed: 11/09/2022] Open
Abstract
Existing studies on pregnancy-related outcomes among cancer survivors are limited by sample size or specificity of the cancer type. This study estimated the burden of adverse maternal and fetal outcomes among pregnant cancer survivors using a national database. This study was a retrospective analysis of National Inpatient Sample collected during 2010-2014. Multivariate regression models were used to calculate odds ratios for maternal and fetal outcomes. The study included a weighted sample of 64,506 pregnant cancer survivors and 18,687,217 pregnant women without cancer. Pregnant cancer survivors had significantly higher odds for death during delivery hospitalization, compared to pregnant women without cancer (58 versus 5 deaths per 100,000 pregnancies). They also had higher odds of severe maternal morbidity (aOR 2.00 [95% CI 1.66-2.41]), cesarean section (aOR 1.27 [95% CI 1.19-1.37]), labor induction (aOR 1.17 [95% CI 1.07-1.29]), pre-eclampsia (aOR 1.18 [95% CI 1.02-1.36]), preterm labor (aOR 1.55 [95% CI 1.36-1.76]), chorioamnionitis (aOR 1.45 [95% CI 1.15-1.82]), postpartum infection (aOR 1.68 [95% CI 1.21-2.33]), venous thromboembolism (aOR 3.62 [95% CI 2.69-4.88]), and decreased fetal movements (aOR 1.67 [95% CI 1.13-2.46]). This study showed that pregnancy among cancer survivors constitutes a high-risk condition requiring advanced care and collective efforts from multiple subspecialties.
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Anaplastic ganglioglioma in pregnancy a cause of cerebral edema and maternal death. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
The true incidence of anaplastic ganglioglioma during pregnancy is extremely rare, very few cases have been reported in the literature.
Case presentation
This is a report of a case of anaplastic ganglioglioma diagnosed in pregnancy. The patient is a 23-year-old primigravida who presented at 19 weeks of gestation headache and a convulsive episode. Her workup revealed a rare cerebral tumor that progressed to a neurological decline and died during the postpartum period.
Conclusions
Anaplastic ganglioglioma is an aggressive counterpart of Glial tumors; in pregnancy they are rare and symptoms are nonspecific. The outcome for the mother in this case fatal and a protocol for these cases has not yet been reported.
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Goyal S, Yadav A, Madan R, Chitkara A, Singh R, Khosla D, Kumar N. Managing brain tumors in pregnancy: The oncologist's struggle with maternal-fetal conflict. J Cancer Res Ther 2022; 18:5-18. [DOI: 10.4103/jcrt.jcrt_1343_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Kavouridis VK, Calvachi P, Cho CH, Smith TR. Patterns of Interaction Between Diffuse Low-Grade Glioma and Pregnancy: An Institutional Case Series. World Neurosurg 2021; 150:e236-e252. [PMID: 33706019 DOI: 10.1016/j.wneu.2021.02.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The occurrence of pregnancy in patients with low-grade glioma (LGG) constitutes a unique therapeutic challenge. Owing to the rarity of cases, there is a dearth of information in existing literature. METHODS We retrospectively identified all patients with a diagnosis of LGG and pregnancy at some point during their illness. Clinical course and obstetrical outcomes were reviewed. A volumetric analysis of tumor growth rate in association with pregnancy was performed. RESULTS Of 15 women identified, 13 (86.7%) had a prepregnancy LGG diagnosis. Of the 2 patients in whom LGG was diagnosed during pregnancy, one underwent upfront surgery, and the other had watchful waiting with resection after 60 weeks. Nine patients (60.0%) remained asymptomatic during pregnancy, while 5 (33.3%) experienced recurrence of seizures. There was one case of transformation of an astrocytoma to glioblastoma during the third trimester, which was resected emergently. In 10 cases, progression occurred after pregnancy at a median interval of 24.2 months (interquartile range 6.6-37.5 months), with progression within 6 months of delivery in 2 cases. Mean (SD) growth rate during pregnancy was 7.8 (22.2) mm/year compared with 0.62 (1.12) mm/year before pregnancy and 0.29 (1.18) mm/year after pregnancy; the difference did not reach statistical significance (P = 0.306). CONCLUSIONS Pregnancy was associated with clinical deterioration in one third of patients. No significant change in growth rate was identified. Time to progression and malignant dedifferentiation were unaffected. Patients with LGG wishing to pursue pregnancy should be counseled regarding the risk of complications, and if pregnancy is pursued, close neurological and obstetrical follow-up is recommended.
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Affiliation(s)
- Vasileios K Kavouridis
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway.
| | - Paola Calvachi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles H Cho
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Molina-Botello D, Rodríguez-Sanchez JR, Cuevas-García J, Cárdenas-Almaraz BV, Morales-Acevedo A, Mejía-Pérez SI, Ochoa-Martinez E. Pregnancy and brain tumors; a systematic review of the literature. J Clin Neurosci 2021; 86:211-216. [PMID: 33775330 DOI: 10.1016/j.jocn.2021.01.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/13/2021] [Accepted: 01/28/2021] [Indexed: 11/19/2022]
Abstract
The incidence of primary brain tumors during pregnancy is uncommon. The etiology of these can range from different genetic syndromes such as Li Fraumeni, neurofibromatosis type I, and hormonal associated tumors. The number of meningiomas gradually tends to increase during pregnancy, suggesting a relationship between non-malignant meningiomas and hormonal changes. Clinical features are non specific or can be misinterpreted with pregnancy symptoms such as headache, vomiting and dizziness. It is worth mentioning that the symptoms due to intracranial tumors are no different in pregnant compared with non pregnant patients. However, retrospective studies in glioma behavior suggested that both tumor volume and growth, increased during pregnancy. These changes were correlated with clinical worsening and increased frequency of seizures. The diagnosis requires a proper neurologic exploration and the support of imaging studies. Treatment of tumors is very controversial since we look for the preservation of both mother and fetus. In theory, the best therapy for the mother will also be the best therapy for the fetus. During pregnancy, ideally the treatment is symptomatic, to preserve the fetus, and definite treatment may be performed after birth; the latter is not always accomplished since patients may present with impending herniation or a malignant tumor for which immediate management is necessary. We intend to give an updated review in the literature on the adequate treatment of brain tumors during pregnancy and the anesthetic management during the definite treatment. Literature data was obtained from Pubmed using the search terms: "Pregnancy", "Brain", "Tumors". A total of forty-three articles were selected.
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Affiliation(s)
- Diego Molina-Botello
- Department of Neurological Surgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" (INNN), 3877 Insurgentes Sur Av, La Fama, Tlalpan, 14269 Mexico City, Mexico; Universidad Anáhuac México, Av Universidad Anáhuac 46, Lomas Anáhuac, 52786 Naucalpan de Juárez, Mexico
| | - Jesus René Rodríguez-Sanchez
- Department of Neurological Surgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" (INNN), 3877 Insurgentes Sur Av, La Fama, Tlalpan, 14269 Mexico City, Mexico
| | - Jesús Cuevas-García
- Department of Neuroanesthesia, National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" (INNN), 3877 Insurgentes Sur Av, La Fama, Tlalpan, 14269 Mexico City, Mexico
| | | | - Adrian Morales-Acevedo
- Hospital Angeles México, Agrarismo 208, Escandón II Secc, Miguel Hidalgo, 11800 México City, Mexico
| | - Sonia Iliana Mejía-Pérez
- Department of Neurological Surgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" (INNN), 3877 Insurgentes Sur Av, La Fama, Tlalpan, 14269 Mexico City, Mexico
| | - Edith Ochoa-Martinez
- Department of Neuroanesthesia, National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" (INNN), 3877 Insurgentes Sur Av, La Fama, Tlalpan, 14269 Mexico City, Mexico.
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Rodrigues AJ, Waldrop AR, Suharwardy S, Druzin ML, Iv M, Ansari JR, Stone SA, Jaffe RA, Jin MC, Li G, Hayden-Gephart M. Management of brain tumors presenting in pregnancy: a case series and systematic review. Am J Obstet Gynecol MFM 2021; 3:100256. [PMID: 33451609 DOI: 10.1016/j.ajogmf.2020.100256] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 12/17/2022]
Abstract
Patients who present with brain tumors during pregnancy require unique imaging and neurosurgical, obstetrical, and anesthetic considerations. Here, we review the literature and discuss the management of patients who present with brain tumors during pregnancy. Between 2009 and 2019, 9 patients were diagnosed at our institution with brain tumors during pregnancy. Clinical information was extracted from the electronic medical records. The median age at presentation was 29 years (range, 25-38 years). The most common symptoms at presentation included headache (n=5), visual changes (n=4), hemiparesis (n=3), and seizures (n=3). The median gestational age at presentation was 20.5 weeks (range, 11-37 weeks). Of note, 8 patients (89%) delivered healthy newborns, and 1 patient terminated her pregnancy. In addition, 5 patients (56%) required neurosurgical procedures during pregnancy (gestational ages, 14-37 weeks) because of disease progression (n=2) or neurologic instability (n=3). There was 1 episode of postneurosurgery morbidity (pulmonary embolism [PE]) and no surgical maternal mortality. The median length of follow-up was 15 months (range, 6-45 months). In cases demonstrating unstable or progressive neurosurgical status past the point of fetal viability, neurosurgical intervention should be considered. The physiological and pharmacodynamic changes of pregnancy substantially affect anesthetic management. Pregnancy termination should be discussed and offered to the patient when aggressive disease necessitates immediate treatment and the fetal gestational age remains previable, although neurologically stable patients may be able to continue the pregnancy to term. Ultimately, pregnant patients with brain tumors require an individualized approach to their care under the guidance of a multidisciplinary team.
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Affiliation(s)
- Adrian J Rodrigues
- Departments of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Anne R Waldrop
- Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Sanaa Suharwardy
- Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Maurice L Druzin
- Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Michael Iv
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Jessica R Ansari
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Sarah A Stone
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Richard A Jaffe
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Michael C Jin
- Departments of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Gordon Li
- Departments of Neurosurgery, Stanford University School of Medicine, Stanford, CA
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A Review of the Neurosurgical Management of Brain Metastases During Pregnancy. Can J Neurol Sci 2020; 48:698-707. [PMID: 33213549 PMCID: PMC8527832 DOI: 10.1017/cjn.2020.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Patients with pregnancy-associated secondary brain tumors (PASBT) are challenging to manage. Because no guidelines for the management of such patients currently exist, we performed a systematic review of the literature using PRISMA guidelines with a discussion of management from a neurosurgeon's perspective. METHOD Systematic review of the literature using PRISMA guidelines from 1999 to 2018. RESULTS We identified 301 studies of which 16 publications (22 patients reporting 25 pregnancies, 20 deliveries, 5 early terminations) were suitable for final analysis. The most frequent primary cancers were breast (8/22, 36.36%), skin (6/22, 27.27%), and lung (5/22, 22.73%). Four patients (18.18%) had neurosurgical procedures during their pregnancies. Five patients (22.73%) received neurosurgical resection after their pregnancies. Nine patients (40.91%) received radiation therapy and seven patients (31.82%) received chemotherapy during pregnancy while seven patients (31.82%) received chemotherapy and radiation after pregnancy. There was 1 fetal death (5%) out of 20 healthy deliveries. Five pregnancies (20%) were terminated in the first trimester due to a need for urgent neurosurgical intervention. CONCLUSION Management of PASBT remains a challenging issue. Maternal and fetal risks associated with surgical resection and teratogenicity due to adjuvant therapy should be discussed in the context of a multidisciplinary team. Timing of surgery and the use of systemic chemoradiation depends on the gestational age (GA) of the fetus, extent, and control of the mother's primary and metastatic disease. Guidelines need to be established to help neuro-oncology teams safely and effectively manage this group of patients.
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Management Challenges of Metastatic Spinal Cord Compression in Pregnancy. Case Rep Surg 2020; 2020:8891021. [PMID: 33204568 PMCID: PMC7652620 DOI: 10.1155/2020/8891021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/13/2020] [Accepted: 10/24/2020] [Indexed: 11/17/2022] Open
Abstract
Primary and secondary spinal tumours with cord compression often represent a challenging condition for the patient and clinicians alike, even more so during pregnancy. The balance between safe delivery of a healthy baby and management of the mother's disease bears many clinical, psychological, and ethical dilemmas. Pregnancy sets a conflict between the optimal surgical and oncological managements of the mother's tumour and the well-being of her foetus. We followed the CARE guidelines from the EQUATOR Network to report an exemplificative case of a 39-year-old woman with a 10-year history of breast cancer, presenting in the second trimester of her first pregnancy with acute onset severe thoracic spinal instability, causing mechanical pain and weakness in lower limbs. Neuroradiological investigations revealed multilevel spinal deposits with a pathological T10 fracture responsible for spinal cord compression. The patient was adamant that she wanted a continuation of the pregnancy and her baby delivered. After discussion with her oncologist and obstetrician, we agreed to perform emergency spinal surgery—decompression and instrumented fixation. The literature search did not reveal a similar case of spinal metastatic breast cancer undergoing spinal instrumentation and delivery of a healthy baby a few months later. Following the delivery, the patient had further oncological treatment, including chemotherapy and radiotherapy. The paucity of such reports prompted us to present this case and highlight the relevance of a multidisciplinary approach involving obstetrician, oncologist, spinal surgeon, and radiologist to guide the optimal decision-making process.
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Esmaeilzadeh M, Uksul N, Hong B, von Kaisenberg C, Scheinichen D, Lang JM, Hermann EJ, Hillemanns P, Krauss JK. Intracranial emergencies during pregnancy requiring urgent neurosurgical treatment. Clin Neurol Neurosurg 2020; 195:105905. [PMID: 32428795 DOI: 10.1016/j.clineuro.2020.105905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/19/2020] [Accepted: 05/07/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite contemporary diagnostic and therapeutic techniques intracranial emergencies in the obstetric setting pose still a major challenge for the clinicians. There are limited guidelines and differing ethical views. Multidisciplinary teams are needed to support the pregnant woman in a way that she can deliver a viable and healthy child. The aim of the present study was to scrutinize the management of intracranial emergencies during pregnancy which needed urgent neurosurgical treatment. PATIENTS AND METHODS Data of all pregnant women who presented with newly diagnosed intracranial pathologies and neurological symptoms caused by these pathologies in an emergency setting were collected over a 10-year period (2008-2018). Patient characteristics including maternal age, gestational age, and preoperative work-up of both mother and fetus were recorded. Furthermore, the surgical treatment, mode of delivery, and neonatal and maternal outcomes were analysed. RESULTS The mean maternal age was 32.7 years and most patients were in their third trimester. There was one twin pregnancy (total of 12 fetuses). Five out of eleven pregnant women suffered from intracerebral haemorrhage (epidural haematoma (1), arteriovenous malformation (1), subarachnoid haemorrhage (2) and intracerebral haemorrhage (1)) and the other six patients had intracranial neoplasms (primary meningeal sarcoma (1), trigeminal schwannoma (1), anaplastic astrocytoma (2), glioblastoma (1) and sphenoid wing meningioma (1)).Neurosurgical procedures were performed via craniotomies in eight patients. A stereotactic biopsy via a frontal burr hole was achieved one patient. The two other patients with subarachnoid haemorrhage due to rupture of PICA aneurysms were treated with coil embolization. Depending on the gestational age and the clinical condition of the pregnant women it was decided to perform an emergency Caesarean section prior to further therapeutic measures in seven patients. Two out of 12 fetuses were unviable. Six women survived, while five women succumbed to the intracranial pathology. CONCLUSION The individualized treatment approach in this peculiar obstetric scenario needs to consider various issues such as the clinical condition of the pregnant woman, prognosis of the disease, gestational age and the status of the pregnancy. The primary concern in this context must be the mother`s health and safety. Caesarean section is the primary mode of delivery in most cases. While contemporary care can insure survival for the majority of infants, maternal mortality still poses an extraordinary challenge. Interdisciplinary consulting of the patient and/or her family is necessary to develop a treatment strategy for both the expectant woman and her offspring.
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Affiliation(s)
| | - Nesrin Uksul
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Bujung Hong
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | | | - Dirk Scheinichen
- Department of Anaesthesiology, Hannover Medical School, Hannover, Germany
| | - Josef M Lang
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Elvis J Hermann
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Peter Hillemanns
- Department of Gynaecology & Obstetrics, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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14
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Barghouthi T, Lemley R, Figurelle M, Bushnell C. Epidemiology of neurologic disease in pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 171:119-141. [PMID: 32736746 DOI: 10.1016/b978-0-444-64239-4.00006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Many neurologic diseases in women are influenced by the physiologic and hormonal changes of pregnancy, and pregnancy itself poses challenges in both treatment and evaluation of these conditions. Some diseases, such as epilepsy and multiple sclerosis, have a high enough prevalence in the young female population to support robust epidemiologic data while many other neurologic diseases, such as specific myopathies and muscular dystrophies, have a low prevalence, with data limited to case reports and small case series. This chapter features epidemiologic information regarding a breadth of neurologic conditions, including stroke, epilepsy, demyelinating disease, peripheral neuropathies, migraine, sleep-disordered breathing, and meningioma, in women in the preconception, pregnancy, and postpartum stages.
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Affiliation(s)
- Tamara Barghouthi
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Regan Lemley
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Morgan Figurelle
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Cheryl Bushnell
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States.
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15
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Sadegh Masoudi M, Zafarshamspour S, Ghasemi-Rad M, Soleimani N, Rakhsha A, Lincoln C. Acute Subdural Hemorrhage of a Convexity Meningioma in the Postpartum Period; Case Report and Literature Review. Bull Emerg Trauma 2019; 7:324-329. [PMID: 31392235 DOI: 10.29252/beat-0703018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
New onset seizures in pregnancy or the postpartum period can be of great importance and denote various underlying pathologies. Eclampsia and cerebrovascular accidents are common, and brain tumors are uncommon causes of postpartum seizures among others. Acute presentation of brain tumors in pregnancy or the postpartum period is extremely rare. Meningiomas are the most common benign intracranial tumors. Although 1.3 to 2.4% of these benign tumors may bleed, acute presentation of them with hemorrhage is quite rare. Herein, we report a rare case of a 36-year-old lady who presented with severe headache, seizure, and loss of consciousness in the postpartum period, five days after delivery of a full-term baby. Primary emergency evaluation revealed an extra-axial lesion with subdural hemorrhage. A Decompressive craniectomy was performed, hematoma was evacuated, and the tumor was totally resected. Histopathologic evaluation was consistent with a fibroblastic meningioma (WHO grade I). She was discharged in good general condition. Our case highlights the significance of complete evaluation of patients with new-onset seizures in pregnancy or the postpartum period. Although uncommon, brain tumors in pregnancy can have potentially devastating outcomes which may necessitate prompt surgical intervention.
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Affiliation(s)
- Mohammad Sadegh Masoudi
- Departmet of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.,Neurotrauma Research Center, AJA University of Medical Sciences, Tehran, Iran
| | | | | | - Neda Soleimani
- Departmemt of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rakhsha
- Departmet of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Christie Lincoln
- Department of Radiology, Baylor college of medicine, Houston, Texas, USA
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16
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Subtotal Resection of an Anaplastic Ganglioglioma in Pregnancy. Case Rep Obstet Gynecol 2018; 2018:4606354. [PMID: 29862102 PMCID: PMC5971236 DOI: 10.1155/2018/4606354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/02/2018] [Accepted: 04/10/2018] [Indexed: 11/22/2022] Open
Abstract
Background Anaplastic ganglioglioma is a rare malignant brain tumor associated with high morbidity and mortality. The diagnosis of a central nervous system malignancy in the early 3rd trimester presents management challenges to both neurosurgeons and obstetricians. Case A 33-year-old woman, gravida 2 para 1, presented at 28 6/7 weeks with four months of worsening headaches, nausea, vomiting, and mental status changes due to a 7.5 cm anaplastic ganglioglioma. Maternal deterioration necessitated subtotal tumor debulking allowing prolongation of the gestation to 34 6/7 weeks. After delivery, the patient underwent further resection, followed by chemotherapy and radiation. Both mother and infant are well. Discussion This case underscores the importance of timely diagnostic imaging in pregnant women and demonstrates subtotal tumor debulking as a viable means of prolonging gestation.
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17
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Roux A, Pallud J. Gravidanza e gliomi diffusi di basso grado. Neurologia 2018. [DOI: 10.1016/s1634-7072(17)87847-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Peeters S, Pagès M, Gauchotte G, Miquel C, Cartalat-Carel S, Guillamo JS, Capelle L, Delattre JY, Beauchesne P, Debouverie M, Fontaine D, Jouanneau E, Stecken J, Menei P, De Witte O, Colin P, Frappaz D, Lesimple T, Bauchet L, Lopes M, Bozec L, Moyal E, Deroulers C, Varlet P, Zanello M, Chretien F, Oppenheim C, Duffau H, Taillandier L, Pallud J. Interactions between glioma and pregnancy: insight from a 52-case multicenter series. J Neurosurg 2017; 128:3-13. [PMID: 28298039 DOI: 10.3171/2016.10.jns16710] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to provide insight into the influence of gliomas on gestational outcomes, the impact of pregnancy on gliomas, and the identification of patients at risk. METHODS In this multiinstitutional retrospective study, the authors identified 52 pregnancies in 50 women diagnosed with a glioma. RESULTS For gliomas known prior to pregnancy (n = 24), we found the following: 1) An increase in the quantified imaging growth rates occurred during pregnancy in 87% of cases. 2) Clinical deterioration occurred in 38% of cases, with seizures alone resolving after delivery in 57.2% of cases. 3) Oncological treatments were immediately performed after delivery in 25% of cases. For gliomas diagnosed during pregnancy (n = 28), we demonstrated the following: 1) The tumor was discovered during the second and third trimesters in 29% and 54% of cases, respectively, with seizures being the presenting symptom in 68% of cases. 2) The quantified imaging growth rates did not significantly decrease after delivery and before oncological treatment. 3) Clinical deterioration resolved after delivery in 21.4% of cases. 4) Oncological treatments were immediately performed after delivery in 70% of cases. Gliomas with a high grade of malignancy, negative immunoexpression of alpha-internexin, or positive immunoexpression for p53 were more likely to be associated with tumor progression during pregnancy. Deliveries were all uneventful (cesarean section in 54.5% of cases and vaginal delivery in 45.5%), and the infants were developmentally normal. CONCLUSIONS When a woman harboring a glioma envisions a pregnancy, or when a glioma is discovered in a pregnant patient, the authors suggest informing her and her partner that pregnancy may impact the evolution of the glioma clinically and radiologically. They strongly advise a multidisciplinary approach to management. ■ CLASSIFICATION OF EVIDENCE Type of question: association; study design: case series; evidence: Class IV.
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Affiliation(s)
- Sophie Peeters
- 1Department of Neurosurgery, Sainte-Anne Hospital, Paris.,2Paris Descartes University, Sorbonne Paris Cité, Paris
| | - Mélanie Pagès
- 2Paris Descartes University, Sorbonne Paris Cité, Paris.,3Department of Neuropathology, Sainte-Anne Hospital, Paris
| | | | | | | | | | - Laurent Capelle
- 8Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris.,25Réseau d'Etude des Gliomes, REG, Groland; and
| | - Jean-Yves Delattre
- 9Department of Neuro-oncology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris
| | | | | | - Denys Fontaine
- 11Department of Neurosurgery, Centre Hospitalier Universitaire de Nice.,25Réseau d'Etude des Gliomes, REG, Groland; and
| | - Emmanuel Jouanneau
- 12Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Bron
| | - Jean Stecken
- 13Department of Neurosurgery, Regional Hospital, Orléans
| | | | - Olivier De Witte
- 15Laboratory of Experimental Neurosurgery and Multidisciplinary Research Institute, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire-Université Libre de Bruxelles,Belgium
| | - Philippe Colin
- 16Department of Radiation, Polyclinique Courlancy, Reims.,25Réseau d'Etude des Gliomes, REG, Groland; and
| | - Didier Frappaz
- 17Department of Pediatric and Adult Neuro Oncology, Centre Léon Bérard et Institut Hematology Oncology Pediatric, Lyon
| | | | - Luc Bauchet
- 19Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier.,25Réseau d'Etude des Gliomes, REG, Groland; and
| | - Manuel Lopes
- 20Department of Neurosurgery, Argonay Private Hospital, Argonay
| | - Laurence Bozec
- 21Department of Medical Oncology, Institut Curie-Hôpital René Huguenin, Saint-Cloud
| | - Elisabeth Moyal
- 22Institut Claudius Regaud, Département de Radiothérapie, Toulouse
| | | | - Pascale Varlet
- 2Paris Descartes University, Sorbonne Paris Cité, Paris.,3Department of Neuropathology, Sainte-Anne Hospital, Paris.,26Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris,France
| | - Marc Zanello
- 1Department of Neurosurgery, Sainte-Anne Hospital, Paris.,2Paris Descartes University, Sorbonne Paris Cité, Paris
| | - Fabrice Chretien
- 2Paris Descartes University, Sorbonne Paris Cité, Paris.,3Department of Neuropathology, Sainte-Anne Hospital, Paris
| | - Catherine Oppenheim
- 2Paris Descartes University, Sorbonne Paris Cité, Paris.,24Department of Neuroradiology, Sainte-Anne Hospital, Paris.,26Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris,France
| | - Hugues Duffau
- 19Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier.,25Réseau d'Etude des Gliomes, REG, Groland; and
| | - Luc Taillandier
- 7Department of Neurology, CHU Caen.,25Réseau d'Etude des Gliomes, REG, Groland; and
| | - Johan Pallud
- 1Department of Neurosurgery, Sainte-Anne Hospital, Paris.,2Paris Descartes University, Sorbonne Paris Cité, Paris.,25Réseau d'Etude des Gliomes, REG, Groland; and.,26Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris,France
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19
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Ventura F, Barranco R, Gentile R, Vergani P. Unexpected and sudden death due to undiagnosed medulloblastoma in twin pregnancy: A case report. Forensic Sci Int 2016; 266:e14-e17. [PMID: 27595435 DOI: 10.1016/j.forsciint.2016.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 11/26/2022]
Abstract
The authors describe an unusual case of sudden and unexpected death caused by a medulloblastoma in a woman aged 28, native of South America, at the 33rd week of twin pregnancy, with neurological signs appeared a month before death. The initial symptoms were attributed to epiphenomena of pregnancy. Two weeks after hospitalization, the woman showed an acute frontal headache that prevented movement and caused a rapid lowering of arterial oxygen saturation. The patient died around 3h later, despite resuscitation. Immediately after, a caesarean section was performed but it was not enough to prevent the death of the two foetuses. The autopsy revealed the presence of a tumour between the left lobe of the cerebellum and the vermis. Histological examination enabled to identify a medulloblastoma. Death was attributed to acute cardio-respiratory insufficiency caused by compression of the brain stem. Foetuses showed no malformation and their death was due to an acute hypoxia resulting from the mother cardiovascular arrest.
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Affiliation(s)
- Francesco Ventura
- Department of Legal and Forensic Medicine, University of Genova, Via De Toni 12, 16132 Genova, Italy.
| | - Rosario Barranco
- Department of Legal and Forensic Medicine, University of Genova, Via De Toni 12, 16132 Genova, Italy
| | - Raffaella Gentile
- Clinical Pathology Service, San Vincenzo Hospital, Contrada Sirina, 98039 Taormina, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, University of Milano Bicocca, Fondazione MBBM, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy
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20
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Murthy SB, Moradiya Y, Shah S, Shastri A, Bershad EM, Suarez JI. In-hospital outcomes of thrombolysis for acute ischemic stroke in patients with primary brain tumors. J Clin Neurosci 2015; 22:474-8. [PMID: 25564270 DOI: 10.1016/j.jocn.2014.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/07/2014] [Accepted: 09/14/2014] [Indexed: 10/24/2022]
Abstract
Data on thrombolysis outcomes in patients with primary brain tumors are limited. Our aim was to study stroke outcomes following thrombolysis in these patients in a population-based study. Patients with acute ischemic stroke who received thrombolysis were identified from the 2002-2011 USA Nationwide Inpatient Sample. We compared demographics, comorbidities, and outcomes between primary brain tumor-associated strokes (BTS) and non-brain tumor associated strokes (NBTS). The main outcomes were inpatient mortality, home discharge and intracranial hemorrhage (ICH) rate. Of the 124,083 thrombolysis-treated stroke patients, 416 (0.34%) had brain tumors. In adjusted analysis, inpatient mortality (odds ratio [OR]: 0.98; 95% confidence interval [CI]: 0.77-1.26, p=0.918), rate of home discharge (OR: 1.15; 95% CI: 0.87-1.53, p=0.40) and rate of ICH (OR: 0.94; 95% CI: 0.62-1.44, p=0.801) were similar between BTS and NBTS. Analysis of brain tumor subtypes showed that compared to NBTS, malignant BTS were independently associated with higher in-hospital mortality (OR: 2.51; 95% CI: 1.66-3.79, p<0.001), lower home discharge (OR: 0.36, 95% CI: 0.18-0.72, p=0.004), and increased risk of ICH (OR: 2.33, 95% CI: 1.49-3.65, p<0.001). Additionally, among the BTS, intraparenchymal location of tumor was associated with higher mortality (OR: 2.51; 95% CI: 1.20-5.23, p=0.014) and lower home discharge (OR: 0.26; 95% CI: 0.13-0.53, p<0.001). Thrombolytic therapy for acute stroke appears to be safe in patients with primary brain tumors, with similar rates of ICH. Malignant BTS have worse outcomes, while benign BTS have outcomes comparable to NBTS. Careful consideration of tumor pathology may aid selection of patients with poor thrombolysis outcomes.
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Affiliation(s)
- Santosh B Murthy
- Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, 600 N Wolf Street, Meyer 8-140, MD 21287, USA.
| | - Yogesh Moradiya
- Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, 600 N Wolf Street, Meyer 8-140, MD 21287, USA
| | - Shreyansh Shah
- Department of Vascular Neurology, National Institutes of Health, Bethesda, MD, USA
| | - Aditi Shastri
- Department of Hematology and Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eric M Bershad
- Department of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA
| | - Jose I Suarez
- Department of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA
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21
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Impact of maternal brain tumours on perinatal and maternal management and outcome: a single referral centre retrospective study. Eur J Obstet Gynecol Reprod Biol 2014; 183:132-6. [DOI: 10.1016/j.ejogrb.2014.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 10/15/2014] [Accepted: 10/22/2014] [Indexed: 11/23/2022]
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22
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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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23
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Verheecke M, Halaska MJ, Lok CA, Ottevanger PB, Fruscio R, Dahl-Steffensen K, Kolawa W, Gziri MM, Han SN, Van Calsteren K, Van den Heuvel F, De Vleeschouwer S, Clement PM, Menten J, Amant F. Primary brain tumours, meningiomas and brain metastases in pregnancy: Report on 27 cases and review of literature. Eur J Cancer 2014; 50:1462-71. [DOI: 10.1016/j.ejca.2014.02.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/12/2014] [Accepted: 02/22/2014] [Indexed: 11/25/2022]
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24
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Hernández-Durán S, Sánchez-Jiménez E, Pérez-Berríos J. Hemangiopericytoma of the foramen magnum in a pregnant patient: A case report and literature review. Surg Neurol Int 2014; 5:13. [PMID: 24678429 PMCID: PMC3942593 DOI: 10.4103/2152-7806.125864] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/10/2014] [Indexed: 11/04/2022] Open
Abstract
Background: The presentation of intracranial hemangiopericytomas is very rare, and only one case of a hemangiopericytoma during pregnancy has been reported in the literature. The management of these lesions poses a great challenge to the neurosurgeon, since the physiological and hormonal changes of pregnancy can exacerbate the symptoms of this highly vascularized neoplasm and pose different risks to both the mother and the fetus. We report the case of a patient who had sudden onset of intracranial hypertension at the ninth week of gestation due to a hemangiopericytoma of the foramen magnum and review the literature in this regard. Case Description: A 23-year-old female who presented with signs and symptoms of intracranial hypertension at the ninth week of gestation was initially thought to have hyperemesis gravidarum. Because her symptoms persisted, she was found to have intracranial hypertension due to a tumor in the foramen magnum. She was treated by means of derivative surgery to allow for her pregnancy to progress beyond the first trimester, and at the 22nd week of gestation she underwent a sub-occipital craniotomy with partial tumor removal. Pathology was consistent with hemangiopericytoma. Both the mother and the fetus had positive outcomes. Conclusions: To our knowledge, this is the second intracranial hemangiopericytoma presenting during pregnancy to be reported in the literature, and it is the first one of its kind to be located in the foramen magnum and causing severe intracranial hypertension.
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Affiliation(s)
- Silvia Hernández-Durán
- University of Costa Rica School of Medicine, Ciudad Universitaria Rodrigo Facio, San Pedro de Montes de Oca, San José, Costa Rica ; Department of Neurological Surgery, Hospital San Juan de Dios, Paseo Colón, San José, Costa Rica
| | - Esteban Sánchez-Jiménez
- Department of Neurological Surgery, Hospital San Juan de Dios, Paseo Colón, San José, Costa Rica
| | - José Pérez-Berríos
- University of Costa Rica School of Medicine, Ciudad Universitaria Rodrigo Facio, San Pedro de Montes de Oca, San José, Costa Rica ; Department of Neurological Surgery, Hospital San Juan de Dios, Paseo Colón, San José, Costa Rica
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25
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Yust-Katz S, de Groot JF, Liu D, Wu J, Yuan Y, Anderson MD, Conrad CA, Milbourne A, Gilbert MR, Armstrong TS. Pregnancy and glial brain tumors. Neuro Oncol 2014; 16:1289-94. [PMID: 24615863 DOI: 10.1093/neuonc/nou019] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Improvements in brain tumor treatments have led to an increase in the number of young women with brain tumors who are now considering pregnancy. The aim of this study is to evaluate the influence of pregnancy on brain tumor biology. METHODS In this institutional review board-approved retrospective study, we searched the institution's database for patients with glial brain tumors who were pregnant at the time of diagnosis or became pregnant during the course of their illness. We identified 34 such patients and reviewed their charts to determine each patient's clinical course and pregnancy outcome. RESULTS Fifteen patients were diagnosed with a primary brain tumor during pregnancy: 3 with glioblastomas, 6 with grade III gliomas, and 6 with grade II gliomas. Pregnancy was terminated in only 2 of these patients, and the remainder delivered healthy babies. Twenty-three patients became pregnant after diagnosis (4 patients were pregnant at diagnosis and again after diagnosis). Of the patients who became pregnant after diagnosis, the 5 with grade I tumors had stable disease during and after pregnancy. However, of the 18 patients with grade II or III gliomas, 8 (44%) had confirmed tumor progression during pregnancy or within 8 weeks of delivery. CONCLUSIONS In contrast to grade I gliomas, the tumor biology of grades II and III gliomas may be altered during pregnancy, leading to an increased risk of tumor progression. These findings support the need for increased tumor surveillance and patient counseling and for additional data collection to further refine these results.
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Affiliation(s)
- Shlomit Yust-Katz
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - John F de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Diane Liu
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Jimin Wu
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Ying Yuan
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Mark D Anderson
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Charles A Conrad
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Andrea Milbourne
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Mark R Gilbert
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Terri S Armstrong
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
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Zwinkels H, Dörr J, Kloet F, Taphoorn MJB, Vecht CJ. Pregnancy in women with gliomas: a case-series and review of the literature. J Neurooncol 2013; 115:293-301. [DOI: 10.1007/s11060-013-1229-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/10/2013] [Indexed: 11/28/2022]
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Chowdhury T, Cappellani RB, Daya J. Neuroanesthetic considerations for emergent extracranial surgeries: What to know? Saudi J Anaesth 2013; 6:408-11. [PMID: 23493049 PMCID: PMC3591564 DOI: 10.4103/1658-354x.105889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Neuroanaesthetic considerations in non neurosurgical cases are utmost important for the optimal management of such cases. These considerations become even more challenging in patients undergoing emergency surgeries. We have highlighted the neuroanesthetic considerations for three broad categories. The two most important considerations in this type of surgery will be the avoidance of secondary brain insult and maintenance of optimal cerebral perfusion pressure.
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Affiliation(s)
- Tumul Chowdhury
- Department of Anesthesiology, Health Sciences Center, University of Manitoba, Winnipeg, Canada
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Wu J, Ma YH, Wang TL. Glioma in the third trimester of pregnancy: Two cases and a review of the literature. Oncol Lett 2013; 5:943-946. [PMID: 23426274 PMCID: PMC3576202 DOI: 10.3892/ol.2013.1106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 12/28/2012] [Indexed: 11/16/2022] Open
Abstract
We present two cases of glioma (WHO grade III) in pregnant females presenting in the third trimester. Gliomas during pregnancy are rare. At present, the association between gliomas and pregnancy is poorly understood and little has been reported with regard to the management of patients with gliomas in pregnancy. Management of these cases presents a medical dilemma. Gliomas during pregnancy pose a risk to maternal and fetal life. The benefit-to-risk ratio should be carefully evaluated and discussed prior to surgery. In the present cases, caesarean section (CS) followed by craniotomy was performed under the same general anesthesia at 34 weeks’ gestation. The mothers received radiotherapy and chemotherapy following surgery. They have been followed up to the present date and remain in good health. These two cases indicate that early CS followed by craniotomy is an effective choice in pregnant patients with gliomas at ≥34 weeks’ gestation. In the present study, we describe these two cases and review the literature with regard to gliomas during pregnancy.
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Affiliation(s)
- Jie Wu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
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