Management of Skull Base Tumors in the Obstetric Population: a Case Series.

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Management of Skull Base Tumors in the Obstetric Population: a Case Series.

World Neurosurg. 2018 Feb 14;:

Authors: Priddy BH, Otto BA, Carrau RL, Prevedello DM

Abstract
BACKGROUND: Neoplasms rarely present during pregnancy. However, increase in plasma volume, hormone release induced growth, and tumor hypervascularity, can cause rapid symptoms. These range from not requiring intervention to necessitating emergent operations.
OBJECTIVE: We describe an algorithm for the management of symptomatic neoplasm in the obstetric population, and provide recommendations regarding surgical indications and timing.
METHODS: Patients who presented to a skull base clinic from 2010-2016 at large tertiary care hospital were reviewed to identify patients who presented with a skull base tumor during pregnancy.
RESULTS: Our cohort comprises ten women with skull base tumors during pregnancy. Four presented symptoms that required emergent skull base surgery, six underwent surgery after delivery or continued surveillance. All patients were found to have WHO Grade I or II meningioma or schwannomas. There were no maternal complications. Through this experience, a management algorithm was created.
CONCLUSION: Management of a symptomatic tumor during pregnancy requires balancing the potential to cure the mother and to harm the fetus. Trimester of pregnancy is the most critical factor in evaluating the need for urgent management. Surgery during the second trimester is the optimal time, as it is associated with the least 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 early third trimester. Nonetheless, any pregnant woman with an emergent presentation should be offered surgery, regardless of trimester.

PMID: 29454125 [PubMed - as supplied by publisher]

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