Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997.

Twelve pregnancies in 11 adult women harboring World Health Organization (WHO) grade II gliomas (GIIGs) prior to pregnancy were reviewed to address whether pregnancy affects tumor growth using a quantitative approach of the radiological velocity of diametric expansion (VDE) on successive magnetic resonance images. VDE was significantly increased during pregnancy as compared to prepregnancy (p < 0.001) and to postdelivery (p = 0.012) periods. Pregnancy increases the radiological growth rates of GIIGs. An increase in seizure frequency was observed concomitantly in 40% of cases and further oncological treatment was started after delivery in 25% of cases.

Pregnancy increases the growth rates of World Health Organization grade II gliomas.

The occurrence of brain tumours during pregnancy is unusual, when this happen jeopardises the lives of both the mother and infant. This article aims at identifying the best medical management to be followed for a pregnant patient harbouring a brain tumour. The records of 10 patients with brain tumours diagnosed during pregnancy were retrospectively examined. The histological diagnosis revealed 3 grade 2 astrocytomas, and 1 grade 2 oligodendroglioma. All this gliomas (100%) developed dedifferentiation in the mean period of 27 months. The histology of the others tumours were 2 grade 1 meningiomas, 1 melanoma metastasis, 1 epidermoid tumour, 1 case of chemodectoma and 1 patient with a pituitary apoplexy in a non-function adenoma. There was no operative mortality in these series, and no fetal deaths were observed. Prior to craniotomy, five patients had caesarean sections, two others had vaginal deliveries. In three patients the delivery took place after the brain tumour treatment. Two patients had vaginal delivery and eight caesarean sections. The best moment to recommend the craniotomy and the neurosurgical removal of the tumour will depend of the mother's neurological condition, the tumour histological type as well as the gestational age. A multi-disciplinary approach was used to determine the optimal management for each patient.

Management strategy for brain tumour diagnosed during pregnancy

Introduction Brain tumors are the fifth leading cause of cancer-related death in women ages 20 to 39 years. Although the presentation of intracranial tumors during pregnancy is relatively uncommon, neurosurgeons and obstetricians will undoubtedly encounter these patients in their everyday practices. And although the diagnosis of a brain tumor is emotionally upsetting for any patient, it is particularly devastating for an expectant mother. The care of these patients poses specific diagnostic and therapeutic challenges that are best managed by a multidisciplinary team of physicians prepared to implement a comprehensive approach to the problematic issues brain tumors raise in pregnant patients. Incidence A study reviewing the central nervous system tumor registry data in East Germany from 1961 to 1979 reported a frequency of 3.6 malignant brain tumors per 10 live births. In a more recent retrospective analysis of select southern California hospital tumor registries from 1978 to 1998, 10 cases of malignant brain tumors diagnosed either antenatally or within 6 weeks postpartum were identified, yielding a relative frequency of 3.2 malignant tumors per 10 births in this population. Both of these studies excluded common benign intracranial neoplasms such as meningiomas, acoustic neuromas, and pituitary adenomas. In 1988, Simon proposed an algorithm utilizing joint probability to calculate the prevalence of brain tumors during pregnancy. Using available statistics on the number of live births per year, number of Correspondence: Reid C. Thompson, MD, T-4224, Medical Center North, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN 37232-2380. E-mail: reid.thompson@vanderbilt.edu

The clinical management of intracranial neoplasms in pregnancy.

While obstetric causes of maternal mortality have declined, non-obstetric causes of maternal morbidity and mortality have increased.1 Among the leading non-obstetric causes are neurosurgical pathologies. Although a pregnant woman is essentially no more susceptible to developing a neurosurgical problem than a non-pregnant one, because of physiological and anatomical changes associated with pregnancy, there are certain diseases that are of particular concern to the neurosurgeon. These are subarachnoid haemorrhage (most commonly caused by cerebral aneurysms and arteriovenous malformations), intracranial tumours, and lower back pain and disc herniation.

The epidemiology, pathophysiology, presentation, investigation and management of each of these neurosurgical problems will be discussed, focusing particularly on how the pregnant state influences each of these factors. Furthermore, brief consideration will be given to the management of ventriculoperitoneal shunts during pregnancy, and some general cautions regarding standard neurosurgical practices in the pregnant woman will also be highlighted.

Evidently, the care of a pregnant woman with a neurosurgical condition requires coherent teamwork between the obstetrician, neurosurgeon and neuroanaesthetist. As will be demonstrated, complex decisions will often need to be made with a significant lack in class 1, or even 2, evidence. Constant communication and discussion between this medical team and the patient is absolutely necessary to achieve optimal care.

### Epidemiology

Spontaneous SAH occurs in 10–20 women per 100 000 pregnancies.2 Although uncommon, this phenomenon has devastating consequences. It is the third most common cause of “indirect death” in pregnant women, accounting for approximately 5% of all maternal deaths,3 and has a substantial maternal mortality of 35–83%.2

### Pathophysiology

There is some indication that the incidence of SAH increases during pregnancy,2 and with maternal age and parity.4 Increased plasma volumes and pregnancy induced hypertension are hypothesised to account for this.2

### Presentation

SAH in pregnancy presents as in the non-pregnant. Clinical features include:

1. sudden …

https://jnnp.bmj.com/content/jnnp/79/7/745.full.pdf

Neurosurgery and pregnancy.

https://escholarship.org/content/qt9v27s954/qt9v27s954.pdf?t=ow47d8

Sidney E. Carpenter

Papers

Obstetric emergencies precipitated by malignant brain tumors.

Papillary thyroid carcinoma manifesting as thyroid storm of pregnancy: Case report