Diagnosis, treatment, and management strategy of meningioma during pregnancy

Abstract

The most common benign tumor of the brain is meningiomas. Usually diagnosed between the ages of 40–60, they are more common in women. Studies have shown a strong relationship between hormones and malignancies. Although meningiomas are slow-growing tumors of the brain, pregnancy seems to induce its growth speed. Studies concerning meningiomas and hormone relationship may explain the reason why symptoms during pregnancy flare. More specifically, the estrogen and progesterone receptor may take an active role through signal transduction in inducing the growth of the tumor. Thus, the dilemma of pregnancy + meningioma arises. In this case, a 21-year-old pregnant with a giant meningioma diagnosed on the symptom of loss of sight is reported. Her pregnancy was terminated, and the tumor was excised. Her vision improved and the histopathological examination showed a progesterone receptor positive meningioma. It is a challenging decision to be made by the physician, the patient and the family when deciding if and when pregnancy should be terminated once an intracranial meningioma is diagnosed.

Management strategies and clinical follow-up of pregnant women with intracranial meningioma

“…The mode of delivery should be discussed previously in a team of specialists, including an obstetrician, an anesthesiologist, and a neurologist. C-section is preferred and considered safer in preventing the stress induced by the Valsalva maneuver, which may further increase intracranial pressure (ICP) [ 1 ].…”

“…Prolactin receptors have also been found in meningiomas and are closely associated with the growth rate [ 1 ]. Due to the abundance of prolactin receptors that produce physiological pituitary hyperplasia, meningiomas are more likely to grow during and after pregnancy.…”

“…In gestational age younger than 10–12 weeks, when organogenesis is still incomplete, anesthetic agents along with anti-epileptic and anti-edema treatments may cause adverse effects on the fetus [ 1 ]. The multidisciplinary team should offer proper advice and information to the family, together with genetic counseling, and a therapeutic abortion would be advised.…”

“…Meningiomas are common primary tumors of the central nervous system, predominantly affecting women between the ages of 40–60 and postmenopausal women [ 1 ]. There is a low incidence at the age of fertility, although there are some hormonal mechanisms involved in their growth and development [ 2 ], an aspect which was provided by epidemiological studies showing a female to male ratio of approximately two or three to one [ 3 – 6 ].…”

Utilization of awake craniotomy for supra-tentorial tumor resection during pregnancy: A technique useful for fetal-maternal wellbeing

“…Its occurrence during pregnancy is not different from adult population comprising about 20% of all brain tumors, with an incidence of 5-6 per 100,000 pregnancies. 4 However, studies have shown relationship between tumor growth and hormonal changes associated with pregnancy. These hormonal changes may be the reason of flaring up of symptoms during pregnancy.…”