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Nair A, Waack A, Sharma S, Hoyt A, Schroeder J. Letter to editor regarding "Neurosurgical emergencies during pregnancy-management dilemmas". Surg Neurol Int 2023; 14:421. [PMID: 38213423 PMCID: PMC10783692 DOI: 10.25259/sni_729_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/07/2023] [Indexed: 01/13/2024] Open
Affiliation(s)
- Ajay Nair
- Department of Neurosurgery, College of Medicine and Life Sciences, University of Toledo, Toledo, United States
| | - Andrew Waack
- Department of Neurosurgery, College of Medicine and Life Sciences, University of Toledo, Toledo, United States
| | - Soumya Sharma
- Department of Neurosurgery, College of Medicine and Life Sciences, University of Toledo, Toledo, United States
| | - Alastair Hoyt
- Department of Neurosurgery, University of Toledo Medical Center, Toledo, United States
| | - Jason Schroeder
- Department of Surgery, University of Toledo Medical Center, Toledo, United States
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2
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Mofatteh M, Mashayekhi MS, Arfaie S, Wei H, Kazerouni A, Skandalakis GP, Pour-Rashidi A, Baiad A, Elkaim L, Lam J, Palmisciano P, Su X, Liao X, Das S, Ashkan K, Cohen-Gadol AA. Awake craniotomy during pregnancy: A systematic review of the published literature. Neurosurg Rev 2023; 46:290. [PMID: 37910275 PMCID: PMC10620271 DOI: 10.1007/s10143-023-02187-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023]
Abstract
Neurosurgical pathologies in pregnancy pose significant complications for the patient and fetus, and physiological stressors during anesthesia and surgery may lead to maternal and fetal complications. Awake craniotomy (AC) can preserve neurological functions while reducing exposure to anesthetic medications. We reviewed the literature investigating AC during pregnancy. PubMed, Scopus, and Web of Science databases were searched from the inception to February 7th, 2023, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Studies in English investigating AC in pregnant patients were included in the final analysis. Nine studies composed of nine pregnant patients and ten fetuses (one twin-gestating patient) were included. Glioma was the most common pathology reported in six (66.7%) patients. The frontal lobe was the most involved region (4 cases, 44.4%), followed by the frontoparietal region (2 cases, 22.2%). The awake-awake-awake approach was the most common protocol in seven (77.8%) studies. The shortest operation time was two hours, whereas the longest one was eight hours and 29 min. The mean gestational age at diagnosis was 13.6 ± 6.5 (2-22) and 19.6 ± 6.9 (9-30) weeks at craniotomy. Seven (77.8%) studies employed intraoperative fetal heart rate monitoring. None of the AC procedures was converted to general anesthesia. Ten healthy babies were delivered from patients who underwent AC. In experienced hands, AC for resection of cranial lesions of eloquent areas in pregnant patients is safe and feasible and does not alter the pregnancy outcome.
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Affiliation(s)
- Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
- Neuro International Collaboration (NIC), London, UK.
| | - Mohammad Sadegh Mashayekhi
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Neuro International Collaboration (NIC), Ottawa, ON, Canada
| | - Saman Arfaie
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, USA
- Neuro International Collaboration (NIC), Montreal, QC, Canada
| | - Hongquan Wei
- Department of 120 Emergency Command Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Arshia Kazerouni
- Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Georgios P Skandalakis
- First Department of Neurosurgery, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ahmad Pour-Rashidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Abed Baiad
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Lior Elkaim
- Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Jack Lam
- Department of 120 Emergency Command Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | | | - Xiumei Su
- Obstetrical Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuxing Liao
- Department of Neurosurgery, Foshan Sanshui District People's Hospital, Foshan, China
- Department of Surgery of Cerebrovascular Diseases, Foshan First People's Hospital, Foshan, China
| | - Sunit Das
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Keyoumars Ashkan
- Neuro International Collaboration (NIC), London, UK
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- King's Health Partners Academic Health Sciences Centre, London, UK
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Aaron A Cohen-Gadol
- The Neurosurgical Atlas, Carmel, IN, USA
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, USA
- Neuro International Collaboration, Indianapolis, IN, USA
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3
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Karbhari N, Thomas AA. Clinical management of brain tumors in pregnancy. Curr Opin Oncol 2022; 34:691-697. [PMID: 36170169 DOI: 10.1097/cco.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We review the diagnostic tools, treatment options, and clinical management for brain tumors diagnosed in pregnancy with consideration for management approaches that are best suited to preserve maternal and fetal health. RECENT FINDINGS Women of child-bearing age are at risk of developing brain tumors and are at increased risk compared with male counterparts for tumors that are hormonally driven. Brain tumors are rare neoplasms, and diagnosis of brain tumors in pregnancy is uncommon, such that management guidelines and treatment recommendations are lacking for most tumor types. We discuss the standard treatment options for brain tumors and the relative risks and safety when these treatments are considered during pregnancy. We review the neoplasms most commonly affecting pregnant women and the existing literature and guidelines. SUMMARY Pregnancy is a unique phase of life in which hormonal, immunologic, and vascular changes may impact tumor growth and presentation. Treatment decisions should consider the symptoms and stability of the pregnant patients, the gestational age and health of the fetus, and the location and behavior of the neoplasm.
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Affiliation(s)
- Nishika Karbhari
- Department of Neurology, Dartmouth Hitchcock Medical Center, Hanover, NH
| | - Alissa A Thomas
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
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Guarracino I, Ius T, Pauletto G, Maieron M, D’Agostini S, Skrap M, Tomasino B. Incidental low grade glioma in young female: an indolent lesion? A case report and a literature review. Clin Neurol Neurosurg 2022; 223:107520. [DOI: 10.1016/j.clineuro.2022.107520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022]
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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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Marakovic J, Chudy D, Muller D, Tomac D, Marcinkovic P, Oreskovic D, Kastelancic A, Raguz M. Malignant transformation of pleomorphic xanthoastrocytoma in pregnant patient: Clinical case and ethical dilemma. Surg Neurol Int 2021; 12:469. [PMID: 34621584 PMCID: PMC8492419 DOI: 10.25259/sni_120_2021] [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] [Received: 02/07/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Pleomorphic xanthoastrocytoma (PXA) is a rare astrocytic tumor, accounting for <1% of astrocytic tumors. Due to its rarity, etiology, natural history, and biologic behavior is not completely explained. We present a case of malignant transformation of a PXA to glioblastoma in pregnant patient 6 month after tumor biopsy. Case Description: A 28-year-old female patient was presented with a newly onset of headache, nausea, and right-sided hemiparesis at 21st week of pregnancy. Magnetic resonance imaging (MRI) revealed cystic mass in the left frontal region. Patient underwent biopsy to confirm pathohistological analysis; the tumor tissue corresponded to an anaplastic PXA. Two weeks after initial biopsy, open surgery along with gross total tumor removal was performed confirming pathohistological analysis. Six months later, after childbirth, and control MRI revealed a recurrent tumor mass: the patient underwent surgical resection and the tumor tissue corresponded to a glioblastoma. The patients were further treated with radiation and chemotherapy according to oncologist. Conclusion: Distinguishing between PXA patients who have a good prognosis and those at risk for early progression is very important for the PXA clinical management. Despite cellular pleomorphism, mitotic index and the extent of resection are shown to be the main predictors for recurrence-free survival and overall survival rates. The standard therapy management is not yet established. Our patient treatment was associated with a significant ethical dilemma. Respecting patient’s wishes to deliver a baby, nor radio or chemo treatments were done. Further studies are necessary to provide factors responsible for malignant transformation of PXA. In addition, in ethically sensitive situation, such as tumor in pregnant patient, good communication, respecting patient’s wishes, and a multidisciplinary teamwork is the key for better outcome.
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Affiliation(s)
- Jurica Marakovic
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia.,School of Medicine University of Zagreb, Zagreb, Croatia
| | - Darko Chudy
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia.,Department of Surgery, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Danko Muller
- School of Medicine University of Zagreb, Zagreb, Croatia.,Department of Pathology and Cytology, Dubrava University Hospital, Zagreb, Croatia
| | - Damir Tomac
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Petar Marcinkovic
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Darko Oreskovic
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | | | - Marina Raguz
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
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Cristobal I, Boado E, Magdaleno F, Antolín E, Bartha J, De la Calle M. Astrocitomas cerebrales y embarazo: un reto obstétrico. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Policicchio D, Doda A, Muggianu G, Dipellegrini G, Boccaletti R. Ethical and therapeutic dilemmas in glioblastoma management during pregnancy: Two case reports and review of the literature. Surg Neurol Int 2019; 10:41. [PMID: 31528379 PMCID: PMC6743686 DOI: 10.25259/sni-86-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 02/04/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction: There are no guidelines about the management of glioblastoma multiforme (GBM) during pregnancy: treatment of these patients presents therapeutic and ethical challenges. Case Description: Two patients, respectively, 28 years old at the 14th week of gestation with a thalamic GBM and 38 years old at the 28th week of gestation with fronto-mesial GBM. Patients and their relatives were deeply informed about the natural history of GBM and potential risks and benefits of surgery, radiotherapy (XRT), and chemotherapy (CTX) for both, mother and fetus. The first patient’s will was to preserve her fetus from any related, even minimal, risk of XRT, and CTX until safe delivery despite progression of GBM, accepting only surgery (tumor debulking and shunting of hydrocephalus). The second one asked to deliver the baby as soon as possible (despite the risks of prematurity) to receive the standard treatments of GBM. The two patients survived, respectively, 16 and 46 months after delivery. The first patient’s son is in good clinical conditions; the second one suffered problems linked to prematurity. Conclusions: Standard treatment of GBM in a pregnant woman could improve the mother’s survival but can expose the fetus to several potential risks. Ethically, relatives should understand that mother has anyway a poor prognosis and, at the same time, fetus prognosis depends on mother’s condition and therapy. It is not possible to warrant absence of risk for both. Considering the absence of guidelines and the relatively poor current data available about management of GBM in a pregnant woman, after a deep explanation of the situation, we think that the will of the mother and her relatives should prevail.
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Affiliation(s)
- Domenico Policicchio
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola 1, 07100 Sassari, Italy
| | - Artan Doda
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola 1, 07100 Sassari, Italy
| | - Giampiero Muggianu
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola 1, 07100 Sassari, Italy
| | - Giosuè Dipellegrini
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola 1, 07100 Sassari, Italy
| | - Riccardo Boccaletti
- Department of Neurosurgery, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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Clinical challenges of glioma and pregnancy: a systematic review. J Neurooncol 2018; 139:1-11. [PMID: 29623596 PMCID: PMC6061223 DOI: 10.1007/s11060-018-2851-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/22/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This review aims to summarize challenges in clinical management of concomitant gliomas and pregnancy and provides suggestions for this management based on current literature. METHODS PubMed and Embase databases were systematically searched for studies on glioma and pregnancy. Observational studies and articles describing expert opinions on clinical management were included. The strength of evidence was categorized as arguments from observational studies, consensus in expert opinions, or single expert opinions. Risk of bias was assessed by the Newcastle-Ottawa Scale (NOS). RESULTS 27 studies were selected, including 316 patients with newly diagnosed (n = 202) and known (n = 114) gliomas during pregnancy. The median sample size was 6 (range 1-65, interquartile range 1-9). Few recommendations originated from observational studies; the remaining arguments originated from consensus in expert opinions. CONCLUSION Findings from observational studies of adequate quality include (1) There is no known effect of pregnancy on survival in low-grade glioma patients; (2) Pregnancy can provoke clinical deterioration and tumor growth on MRI; (3) In stable women at term, there is no benefit of cesarean section over vaginal delivery, with respect to adverse events in mother or child. Unanswered questions include when pregnancy should be discouraged, what best monitoring schedule is for both mother and fetus, and if and how chemo- and radiation therapy can be safely administered during pregnancy. A multicenter individual patient level meta-analysis collecting granular information on clinical management and related outcomes is needed to provide scientific evidence for clinical decision-making in pregnant glioma patients.
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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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11
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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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Al-Rasheedy IM, Al-Hameed FM. Advanced case of glioblastoma multiforme and pregnancy. An ethical dilemma. ACTA ACUST UNITED AC 2016; 20:388-91. [PMID: 26492122 PMCID: PMC4727635 DOI: 10.17712/nsj.2015.4.20150069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Glioblastoma multiforme (GBM) is the most common and malignant form of the glial tumors. Advanced and treated GBM is rarely associated with pregnancy for many reasons. Glioblastoma multiforme presenting during pregnancy carries unique challenges to the patient, baby, family, and health care providers. We describe an unusual case of advanced GBM that was treated with maximum doses of chemotherapy and radiations, and she became pregnant and presented at eighteenth weeks of gestation. Her medical management was associated with a significant ethical dilemma. We managed to deliver the baby safely through cesarean section at week 28 despite the critical condition of the mother. Unfortunately, the mother died 2 weeks post delivery. We concluded that although recurrent and treated GBM is rarely associated with pregnancy and carries dismal prognosis, but if it occurs, it can still be carried, and a multidisciplinary team work is the key for successful outcome.
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Affiliation(s)
- Intisar M Al-Rasheedy
- Department of Medical Oncology, Princess Norah Oncology Center, Jeddah, Kingdom of Saudi Arabia
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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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14
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