Management Strategy for Meningioma in Pregnancy: A Clinical Study

Abstract

We retrospectively studied 18 pregnant women from 600 cases of meningioma treated at this Institution between 1986 and 2001. The variables evaluated included clinical presentation; radiological findings; timing and extent of surgical resection; and an overview of gestational, clinical, and surgical outcomes. Visual impairment was the chief complaint followed by headache and seizures. The tumors involved the tuberculum sella (8), sphenoid wing (4), convexity (2), parasellar (2), cerebellopontine angle (CPA) (1), and anterior falx (1). Gross total resection was achieved in 14, and subtotal resection was achieved in two patients. There were no related fetal or maternal deaths. Of seven patients with advanced or progressive visual impairment who underwent resection during pregnancy, three improved noticeably, two worsened, and two were unchanged. Five other patients with visual disturbance achieved full-term spontaneous delivery with improved vision in two and improved vision after post-confinement surgery in one. Vision remained unchanged in two. Intracranial meningioma during pregnancy challenges the skill of obstetricians and neurosurgeons to secure delivery of the baby and resection of the tumor. Advances in fetal and maternal monitoring, neuroanesthesia, and microsurgical techniques allow safe neurosurgical management of these patients, and pregnancy usually continues successfully to term. Surgical intervention has no major effect on minimal residual vision or advanced optic nerve atrophy.

Patient Gender Is Associated with Distinct Patterns of Chromosomal Abnormalities and Sex Chromosome–Linked Gene-Expression Profiles in Meningiomas

“…In line with this, previous reports have shown a higher growth rate of meningiomas during both pregnancy [21][22][23] and the luteal phase of the menstrual cycle [24], and an association has been observed between meningioma and breast cancer [25][26][27]. In addition, meningioma tumor cells frequently express progesterone receptors (PRs) [28 -30] and, to a lesser extent, estrogen receptors (ERs) [31,32] and androgen receptors (ARs) [33] as well; PR expression has been correlated with disease outcome [15, 16, 28 -30, 34, 35], and progesterone has been shown to modulate the in vitro growth of meningioma cells [36], although modest results were observed after treatment of meningioma patients [37,38].…”

Endovascular Embolisation of Hepatic Pseudoaneurysm Causing Massive Hemorrhage in a Blunt Hepatic Trauma Patient

“…Bu mekanizmalardan en fazla karşımıza çıkanı hormonal uyarılara bağlı geliştiği kabul edilen hızlanmış büyüme özelliğidir [4][5][6][7][8]. Literatürde gebelik sırasında oluşturdukları kitle etkisi nedeniyle manifest hale gelerek tanı alan, değişik lokalizasyonlarda yerleşmiş meningiom olguları mevcut olmasına rağmen, bu olguların çok büyük kısmını optik sinirlere yakın komşulukları nedeniyle, hafif boyut artışlarında bile vizüel bulgularla semptomatik hale gelebilen tüberkulum sella meningiomları oluşturmaktadır [3]. Bu lokalizasyondaki meningiomların gebelikte manifest hale gelmesinde pitüiter bezde gebelik sırasında görülen ve hormonal uyarıya yanıt olarak geliştiği düşünülen boyut artışının etkisinin olabileceği de düşünülmektedir [2].…”

“…Gebelik sırasında ise sahip olabildikleri hormon reseptörlerine bağlı olarak hızlanmış büyüme özelliği sergileyebildikleri ve hızlı gelişen nörolojik bulgular oluşturabildikleri literatürde bildirilmiştir [1]. Bu olguların çok büyük kısmı hafif boyut artışında bile vizüel semptomlarla manifest hale gelebilen parasellar bölge meningiomlarıdır [2,3].…”

Ophthalmic Complications and Ocular Changes in Pregnancy- A Review

“…Parturients become symptomatic once the tumor reaches a certain threshold, complaining of decreased vision and visual field loss [55]. Treatment for symptomatic patients is usual surgical [56]. However, mild symptoms can be observed with treatments occurring in the postpartum.…”