Symptomatic intracranial tumors in pregnancy: an updated management algorithm. Illustrative case

• Type of Material: Article
• Authors: Youssef M. Zohdy, Emory University; Matthew Agam, Emory University; Justin Maldonado, Emory University; Arman Jahangiri, Emory University; Gustavo Pradilla, Emory University; Tomas Garzon-Muvdi, Emory University
• Language: English
• Date: 2023-05-01
• Publisher: AANS
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The authors
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3171/CASE2399
• Title of Journal or Parent Work: Journal of Neurosurgery: Case Lessons
• Volume: 5
• Issue: 19
• Keywords: aneurysmal bone cyst; EVD; intracranial pressure; ICP; brain tumor in pregnancy; external ventricular drain; hemodynamic change
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Neuroscience

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.