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Durán-Ojeda A, Campos-Fajardo S, Suárez-Monsalve S, Lindado-Pacheco CA, Becerra-Ospina JE. Endoscopic Third Ventriculostomy for the Management of Obstructive Hydrocephalus in Pregnancy: A Case Report and Review of the Literature. J Neurol Surg Rep 2024; 85:e59-e65. [PMID: 38742141 PMCID: PMC11090683 DOI: 10.1055/s-0044-1786822] [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: 03/19/2024] [Accepted: 04/06/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Hydrocephalus is a condition characterized by the abnormal accumulation of cerebrospinal fluid within the brain's ventricular system. It can stem from obstructive and nonobstructive causes. Pregnancy introduces physiopathological changes that may heighten the risk of developing or worsening symptomatic hydrocephalus. Nevertheless, comprehensive reports on this aspect, especially regarding surgical interventions, remain scarce. Case Report A young woman with a history of recurrent headaches experienced a worsening of her symptoms at the onset of her pregnancy. A magnetic resonance imaging (MRI) in the first trimester revealed increased ventricular dilation, indicating an obstructive cause due to aqueduct stenosis. During a neurosurgical board meeting, treatment options were discussed, considering the identifiable obstruction, the heightened intra-abdominal pressure associated with pregnancy, and the risk of ventricular shunt dysfunction. The patient underwent an endoscopic third ventriculostomy (ETV) without complications, leading to both symptom relief and a successful conclusion to the pregnancy. Discussion Neurosurgical procedures in pregnant women are uncommon due to the increased risks to both the mother and the fetus. However, when performed by a qualified multidisciplinary team, they can lead to positive outcomes. In cases of hydrocephalus during pregnancy, ETV appears to be a viable alternative for surgical intervention, particularly when hydrocephalus becomes symptomatic and an obstructive cause is identified, whether in patients with existing shunts or those with newly developed hydrocephalus.
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Affiliation(s)
- Alejandro Durán-Ojeda
- Neurosurgery Research Group, NeuroAxis SAS, Bogotá, Colombia
- Department of Clinical Epidemiology, Universidad de los Andes, Bogotá, Colombia
| | | | - Silvia Suárez-Monsalve
- Neurosurgery Research Group, NeuroAxis SAS, Bogotá, Colombia
- Department of Clinical Epidemiology, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Alberto Lindado-Pacheco
- Neurosurgery Research Group, NeuroAxis SAS, Bogotá, Colombia
- Department of Neurosurgery, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jaime Eduardo Becerra-Ospina
- Neurosurgery Research Group, NeuroAxis SAS, Bogotá, Colombia
- Department of Neurosurgery, Pontificia Universidad Javeriana, Bogotá, Colombia
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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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El Abbassi I, Benaaguida H, Jalal M, Lamrissi A, Bouhya S. Cerebral meningioma during pregnancy mimicking eclampsia: About a rare case. Int J Surg Case Rep 2023; 111:108786. [PMID: 37699284 PMCID: PMC10498165 DOI: 10.1016/j.ijscr.2023.108786] [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: 08/22/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Pregnancy is a physiological state whose association with any pathology gives it specific characteristics in the management of patients. Meningioma is the most frequent brain tumor but rarely develops during pregnancy. Treatment of the tumor generally follows the same principle as that proposed outside pregnancy, with priority given to the mother's life. PRESENTATION OF CASE We report a rare case of gestational meningioma that was wrongly attributed to prepartum eclampsia, in a poorly monitored pregnancy estimated at 34 weeks' amenorrhea, which resulted in the termination of the pregnancy by cesarean section for maternal rescue. The patient underwent complete surgical removal of the tumor postpartum. DISCUSSION Cerebral meningioma in pregnancy is a rare but often fatal disease characterized by unusual behavior compared to meningiomas in non-pregnant women. It is suspected that endocrine and vascular changes play a crucial role in the pathophysiology of rapid tumor growth during pregnancy. The tumor's harmful effect on the fetus is not direct but is mediated by its consequences, such as intracranial hypertension and epileptic seizures, which can be life-threatening for both mother and fetus and in some cases necessitate termination of pregnancy. CONCLUSION The management of cerebral meningioma during pregnancy must take into account the gestational-fetal pairing, both in diagnosis and treatment. This requires close coordination and collaboration between various experts, including anesthetists, obstetricians, neurosurgeons, and pediatricians.
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Affiliation(s)
- I El Abbassi
- Obstetrics and Gynecology Department, Univesity Hospital Center Ibn Rochd, Casablanca, 20100, Morocco.
| | - H Benaaguida
- Obstetrics and Gynecology Department, Univesity Hospital Center Ibn Rochd, Casablanca, 20100, Morocco
| | - M Jalal
- Obstetrics and Gynecology Department, Univesity Hospital Center Ibn Rochd, Casablanca, 20100, Morocco
| | - A Lamrissi
- Obstetrics and Gynecology Department, Univesity Hospital Center Ibn Rochd, Casablanca, 20100, Morocco
| | - S Bouhya
- Obstetrics and Gynecology Department, Univesity Hospital Center Ibn Rochd, Casablanca, 20100, Morocco
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Zohdy YM, Agam M, Maldonado J, Jahangiri A, Pradilla G, Garzon-Muvdi T. Symptomatic intracranial tumors in pregnancy: an updated management algorithm. Illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE2399. [PMID: 37158391 PMCID: PMC10550691 DOI: 10.3171/case2399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/05/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Intracranial tumors are infrequently encountered during pregnancy, and their diagnosis and management require a multidisciplinary approach to ensure the best possible outcomes for the mother and fetus. The pathophysiology and manifestations of these tumors are influenced by hormonal changes, hemodynamic modifications, and alterations in immunological tolerance that occur during pregnancy. Despite the complexity of this condition, no standardized guidelines exist. This study aims to highlight the key points of this presentation, along with the discussion of a possible management algorithm. OBSERVATIONS The authors report the case of a 35-year-old woman who presented during the third trimester of pregnancy with severe signs of increased intracranial pressure (ICP) due to a posterior cranial fossa mass. The decision was made to stabilize the patient by placing an external ventricular drain to temporize her increased ICPs until the baby could be safely delivered via cesarean section. The mass was resected via suboccipital craniectomy 1 week postpartum. LESSONS In considering treatment modalities and their timing in patients presenting with intracranial tumors during pregnancy, each patient should be managed on the basis of an individual treatment algorithm. Symptoms, prognosis, and gestational age should be taken into account to optimize the surgical and perioperative outcomes of both the mother and fetus.
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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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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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Fu Z, Zhu G, Wang L, Hu S, Cheng L, Liu F. Case Report: A Pregnant Woman Diagnosed as ALK-Rearrangement Lung Large Cell Neuroendocrine Cancer With Brain Metastasis. Front Oncol 2022; 12:823813. [PMID: 35280726 PMCID: PMC8916559 DOI: 10.3389/fonc.2022.823813] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/07/2022] [Indexed: 11/16/2022] Open
Abstract
Concomitant malignant tumors and pregnancy present many difficult questions to both clinicians and patients. Due to no specific guidelines, each aspect of clinical management requires special considerations. This current report presents a rare case of a 38-year-old pregnant woman at gestational age 33 weeks with complaints of weakness of her right limbs for 2 weeks. After successive cesarean section and craniotomy, a diagnosis of lung large cell neuroendocrine carcinoma (LCNEC) metastatic to the brain was eventually made. Next generation sequencing (NGS) showed ALK-EML4 gene fusion. Immediately afterwards she was started on the targeted therapy with the ALK inhibitor alectinib. Ten months later, all known lesions exhibited a rapid regression, and no new brain metastases were found. Consequently, the therapeutic effect was considered as a partial response. Then, we review the previous literature using PubMed on maternal malignant brain tumors diagnosed during pregnancy, or lung LCNEC associated with ALK fusion, or ALK inhibitors treatment among the pregnant women, eventually, and discuss the concerns of dealing with these patients.
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Affiliation(s)
- Zaixiang Fu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ganggui Zhu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Liquan Wang
- Department of Obstetrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shen Hu
- Department of Obstetrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Cheng
- Department of Pathology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fuyi Liu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Fuyi Liu,
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Ramachandran A, Segaran S, Nikithamani, Ranjan RV. Neuraxial anaesthesia in a parturient with space occupying lesion in brain for caesarean section: Demystifying the myth – A case report with review. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.4103/joacc.joacc_94_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Al-Shami H, Alnemare AK, Mahfoz TB, Salah AM. Traumatic Frontal Sinus Fractures Management: Experience from High-Trauma Centre. Korean J Neurotrauma 2021; 17:15-24. [PMID: 33981639 PMCID: PMC8093022 DOI: 10.13004/kjnt.2021.17.e3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/10/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022] Open
Abstract
Objective Analysis of our traumatic brain injury data, reviewing current literatures and assessing planning valuable decision making in frontal sinus fracture for young neurosurgeons. Methods Hospital data base for head trauma was retrieved after board permission for retrospective analysis of cases admitted from 2010-2020. Patients with frontal sinus fractures and head trauma were identified according to a flow chart. Variables of the study included patients' demographics, mechanism of injury, incidence of cerebrospinal fluid (CSF) leakage, types of associated injuries, imaging findings and operative techniques. Results Three-hundred eighty two patients were eligible to be screened in our study and represented the sample size under investigations in the following sections, 206 (53.9%) of patients were treated conservatively while 176 patients (46.1%) were identified as having an indication for surgical intervention. Eighty-four percent of patients were males. The mean age was 36.2±9.4 years (14-86 years). Depressed skull fracture was commonly associated injury (17.61%). Leakage of CSF was found in 32.95% of patients. Conclusion Frontal sinus fracture is not an easy scenario. It harbors many proportions and deliver many varieties in which, deep understanding of anatomy, naso-frontal outflow tract status, CSF leakage and neurological injury are of important points in decision. Our institutional algorithm provide rapid, accessible and applicable treatment protocol for resident and young neurosurgeons which minimizes consultations of other specialties.
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Affiliation(s)
- Hieder Al-Shami
- Department of Neurosurgery, Al-Ahly Bank Hospital, Cairo, Egypt
| | - Ahmad K. Alnemare
- Department of Otolaryngology, College of Medicine, Majmaah University, Majmaah, Saudi Arabia
| | - Turki Bin Mahfoz
- Department of Otolaryngology, Faculty of Medicine, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Ahmed M. Salah
- Department of Neurosurgery, Faculty of Medicine, Kasr Al-Ainy Medical College, Cairo, Egypt
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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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Anesthetic Management for Cesarean Delivery in a Patient with a Gigantic Intracranial Tumor. Case Rep Anesthesiol 2020; 2020:9792580. [PMID: 32328312 PMCID: PMC7171641 DOI: 10.1155/2020/9792580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/17/2020] [Indexed: 12/01/2022] Open
Abstract
A 31-year-old G5P1 patient with unremarkable past medical history at 29 weeks of gestation was diagnosed with a gigantic left frontotemporal brain mass. Initial clinical management as an inpatient achieved an improvement in the symptoms. The patient and surgical team agreed to schedule a cesarean delivery at 32 weeks of gestation if no neurological deterioration was observed. Intraoperative course with general endotracheal anesthesia and bilateral transversus abdominis plane block was uneventful and promoted efficient postoperative pain control. Seven days after delivery, the patient underwent craniotomy for brain tumor resection. This report describes the anesthetic management of a patient with an intracranial tumor during pregnancy.
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12
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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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13
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Priddy BH, Otto BA, Carrau RL, Prevedello DM. Management of Skull Base Tumors in the Obstetric Population: A Case Series. World Neurosurg 2018; 113:e373-e382. [PMID: 29454125 DOI: 10.1016/j.wneu.2018.02.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Neoplasms rarely present during pregnancy; however, increases in plasma volume, hormone release-induced growth, and tumor hypervascularity can cause rapidly progressive symptoms of varying severity, ranging from those not requiring intervention to those necessitating emergent operations. Here we describe an algorithm for the management of symptomatic neoplasms in the obstetric population and provide recommendations for surgical indications and timing. METHODS Patients who presented to the skull base clinic at a large tertiary care hospital between 2010 and 2016 were reviewed to identify those who presented with a skull base tumor during pregnancy. RESULTS Our study cohort comprised 9 women with a skull base tumor during pregnancy. Four patients presented with symptoms that necessitated emergent skull base surgery, and 5 underwent surgery after delivery or were followed with continued surveillance. All operated patients had a World Health Organization grade I or II meningioma or schwannoma. There were no maternal complications. Based on our experience with this cohort, we have created a management algorithm. CONCLUSIONS Management of a symptomatic tumor during pregnancy requires balancing the potential for curing the mother and the risk of harming the fetus. Trimester of pregnancy is the most critical factor in evaluating the need for urgent management. The second trimester is the optimal time for surgery, associated with the lowest risk for spontaneous abortion or preterm birth. The first and third trimesters are associated with increased risk of miscarriage and preterm labor, respectively. Induction of labor for preterm delivery, followed by surgery, may be appropriate in the early third trimester. Regardless of the perceived risk, however, all pregnant women with an emergent presentation should be offered surgery, regardless of trimester.
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Affiliation(s)
- Blake H Priddy
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Bradley A Otto
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA; Department of Otolaryngology Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA; Department of Otolaryngology Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Daniel M Prevedello
- Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA; Department of Otolaryngology Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
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Pereira CE, Lynch JC. Management strategies for neoplastic and vascular brain lesions presenting during pregnancy: A series of 29 patients. Surg Neurol Int 2017; 8:27. [PMID: 28303207 PMCID: PMC5339909 DOI: 10.4103/2152-7806.200575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 12/12/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The occurrence of a brain tumor or intracranial vascular lesion during pregnancy is a rare event, but when it happens, it jeopardizes the lives of both the mother and infant. It also creates challenges of a neurosurgical, obstetric, and ethical nature. A multidisciplinary approach should be used for their care. METHODS Between 1986 and 2015, 12 pregnant women diagnosed with brain tumors and 17 women with intracranial vascular lesion underwent treatment at the Neurosurgery Department of the Servidores do Estado Hospital and Rede D'Or/São Luis. The Neurosurgery Department teamed up with Obstetrics Anesthesiology Departments in establishing the procedures. The patients' records, surgical descriptions, imaging studies, and histopathological material were reviewed. RESULTS Among 12 patients presenting with brain tumors, there were neither operative mortality nor fetal deaths. Among the vascular lesions, aneurysm rupture was responsible for bleeding in 6 instances. Arteriovenous malformation was diagnosed in 7 patients. In this subgroup, the maternal and fetal mortality rates were 11.7% and 23.7%, respectively. CONCLUSIONS We can assert that the association between a brain tumor and vascular lesions with pregnancy is a very unusual event, which jeopardizes both the lives of the mother and infant. It remains incompletely characterized due to the rare nature of these potentially devastating events. Knowing the exact mechanism responsible for the interaction of pregnancy and with these lesions will improve the treatment of these patients.
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Affiliation(s)
| | - Jose Carlos Lynch
- Neurosurgical and Obstetrics Departments of Servidores do Estado Hospital, RJ, Brazil
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15
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Belova LA. Dipyridamole in the treatment and prevention of cerebral venous thrombosis in women using hormonal contraceptives. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:116-123. [DOI: 10.17116/jnevro2017117121116-123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Sharma A, Nguyen HS, Lozen A, Sharma A, Mueller W. Brain metastases from breast cancer during pregnancy. Surg Neurol Int 2016; 7:S603-6. [PMID: 27656319 PMCID: PMC5025954 DOI: 10.4103/2152-7806.189730] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/14/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Brain metastasis during pregnancy is a rare occurrence. In particular, there have only been three prior cases regarding breast cancer metastasis. We report a patient with breast cancer metastasis to the brain during pregnancy and review the literature. CASE DESCRIPTION The patient was a 35-year-old female with a history of breast cancer (estrogen receptor/progesterone receptor negative, human epidermal growth factor receptor 2/neu positive, status post-neoadjuvant docetaxel/carboplatin/trastuzumab/pertuzumab therapy, status post-bilateral mastectomies), and prior right frontal brain metastases (status post-resection, capecitabine/lapatinib/temozolomide therapy, and cyberknife treatment). Patient was found to be pregnant at 9 weeks' gestation while on chemotherapy; the patient elected to continue with the pregnancy and chemotherapy was discontinued. At 14 weeks' gestation, she returned with recurrent right frontal disease. She was taken for a craniotomy at 16 weeks' gestation, which confirmed metastases. Six weeks later, patient returned with worsening headaches and fatigue, with more recurrent right frontal disease. She was started on decadron and chemotherapy (5-fluorouracil, adriamycin, and cyclophosphamide). Serial magnetic resonance imaging (MRI) demonstrated enlarging right frontal lesions. She underwent a craniotomy at 27 weeks' gestation, and chemotherapy was discontinued promptly. Starting at 30 weeks' gestation, she received whole brain radiation for 2 weeks. Subsequently, she delivered a baby girl via cesarean section at 32 weeks' gestation. At 6 weeks follow-up, an MRI brain demonstrated no new intracranial disease, with stable postoperative findings. CONCLUSION There is a lack of guidelines and clinical consensus on medical and surgical treatment for breast cancer metastases in pregnant patients. Treatment usually varies based upon underlying tumor burden, location, gestational age of the fetus, and patient's preference and symptomatology.
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Affiliation(s)
- Ashish Sharma
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ha Son Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew Lozen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Abhishiek Sharma
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wade Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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17
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Aissi M, Boughammoura-Bouatay A, Frih-Ayed M, Younes S. [Cerebral venous thrombosis during pregnancy]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2016; 44:129-31. [PMID: 26852065 DOI: 10.1016/j.gyobfe.2015.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Indexed: 11/15/2022]
Affiliation(s)
- M Aissi
- Service de neurologie, CHU de Monastir, Monastir, Tunisie.
| | | | - M Frih-Ayed
- Service de neurologie, CHU de Monastir, Monastir, Tunisie
| | - S Younes
- Service de médecine interne, Mahdia, Tunisie
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18
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Fischer T, Grab D, Grubert T, Hantschmann P, Kainer F, Kästner R, Kentenich C, Klockenbusch W, Lammert F, Louwen F, Mylonas I, Pildner von Steinburg S, Rath W, Schäfer-Graf UM, Schleußner E, Schmitz R, Steitz HO, Verlohren S. Maternale Erkrankungen in der Schwangerschaft. FACHARZTWISSEN GEBURTSMEDIZIN 2016. [PMCID: PMC7158353 DOI: 10.1016/b978-3-437-23752-2.00017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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