Meningioma during pregnancy: what can influence the management? A case series and review of the literature

Carbone, Luigi; Somma, Teresa; Iorio, Giuseppe Gabriele; Vitulli, Francesca; Conforti, Alessandro; Raffone, Antonio; Bove, Ilaria; Pagano, Serena; Pontillo, M.; Carbone, Ilma Floriana; Farina, Antonio; Maruotti, Giuseppe Maria; Maiuri, Francesco; Cappabianca, Paolo

doi:10.1080/14767058.2021.2004585

Cited by 7 publications

(19 citation statements)

References 64 publications

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“…The exclusion of women with a pregnancy beginning in the two years preceding the index date ensured that estimates of the risks associated with progestogen use were reliable. Pregnancy is a unique state, affecting exposure to progestogens (of endogenous or exogenous origin), the likelihood of a meningioma appearing or increasing in volume, 9 58 59 and the likelihood of admission to hospital for surgery (possibly with a lower surgery rate, depending on the symptoms, maternal and foetal health, and tumour characteristics). 59 …”

Section: Discussionmentioning

confidence: 99%

“…Pregnancy is a unique state, affecting exposure to progestogens (of endogenous or exogenous origin), the likelihood of a meningioma appearing or increasing in volume, 9 58 59 and the likelihood of admission to hospital for surgery (possibly with a lower surgery rate, depending on the symptoms, maternal and foetal health, and tumour characteristics). 59 …”

Section: Discussionmentioning

confidence: 99%

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Use of progestogens and the risk of intracranial meningioma: national case-control study

Roland,

Neumann,

Hoisnard

et al. 2024

BMJ

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Objective To assess the risk of intracranial meningioma associated with the use of selected progestogens. Design National case-control study. Setting French National Health Data System (ie, Système National des Données de Santé ). Participants Of 108 366 women overall, 18 061 women living in France who had intracranial surgery for meningioma between 1 January 2009 and 31 December 2018 (restricted inclusion periods for intrauterine systems) were deemed to be in the case group. Each case was matched to five controls for year of birth and area of residence (90 305 controls). Main outcome measures Selected progestogens were used: progesterone, hydroxyprogesterone, dydrogesterone, medrogestone, medroxyprogesterone acetate, promegestone, dienogest, and intrauterine levonorgestrel. For each progestogen, use was defined by at least one dispensation within the year before the index date (within three years for 13.5 mg levonorgestrel intrauterine systems and five years for 52 mg). Conditional logistic regression was used to calculate odds ratio for each progestogen meningioma association. Results Mean age was 57.6 years (standard deviation 12.8). Analyses showed excess risk of meningioma with use of medrogestone (42 exposed cases/18 061 cases (0.2%) v 79 exposed controls/90 305 controls (0.1%), odds ratio 3.49 (95% confidence interval 2.38 to 5.10)), medroxyprogesterone acetate (injectable, 9/18 061 (0.05%) v 11/90 305 (0.01%), 5.55 (2.27 to 13.56)), and promegestone (83/18 061 (0.5%) v 225/90 305 (0.2 %), 2.39 (1.85 to 3.09)). This excess risk was driven by prolonged use (≥one year). Results showed no excess risk of intracranial meningioma for progesterone, dydrogesterone, or levonorgestrel intrauterine systems. No conclusions could be drawn concerning dienogest or hydroxyprogesterone because of the small number of individuals who received these drugs. A highly increased risk of meningioma was observed for cyproterone acetate (891/18 061 (4.9%) v 256/90 305 (0.3%), odds ratio 19.21 (95% confidence interval 16.61 to 22.22)), nomegestrol acetate (925/18 061 (5.1%) v 1121/90 305 (1.2%), 4.93 (4.50 to 5.41)), and chlormadinone acetate (628/18 061 (3.5%) v 946/90 305 (1.0%), 3.87 (3.48 to 4.30)), which were used as positive controls for use. Conclusions Prolonged use of medrogestone, medroxyprogesterone acetate, and promegestone was found to increase the risk of intracranial meningioma. The increased risk associated with the use of injectable medroxyprogesterone acetate, a widely used contraceptive, and the safety of levonorgestrel intrauterine systems are important new findings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of progestogens and the risk of intracranial meningioma: national case-control study

Roland,

Neumann,

Hoisnard

et al. 2024

BMJ

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“…But the rarity of this condition does not allow to clearly define the risk and the need for surgery during pregnancy. Usually, urgent neurosurgery can be indicated during pregnancy in case of neurological symptoms such as motor deficit or visual impairment (39,40). For asymptomatic meningiomas, a multidisciplinary approach is always useful to better evaluate the pros and cons of surgery during pregnancy and following management both for maternal and fetal health, the aim being, as far as possible, to organize the surgery away from childbirth (41).…”

Section: Meningiomas and Sex Hormonesmentioning

confidence: 99%

Spinal meningiomas, from biology to management - A literature review

Serratrice

Lameche²,

Attieh³

et al. 2023

Front. Oncol.

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Meningiomas arise from arachnoidal cap cells of the meninges, constituting the most common type of central nervous system tumors, and are considered benign tumors in most cases. Their incidence increases with age, and they mainly affect females, constituting 25-46% of primary spinal tumors. Spinal meningiomas could be detected incidentally or be unraveled by various neurological symptoms (e.g., back pain, sphincter dysfunction, sensorimotor deficits). The gold standard diagnostic modality for spinal meningiomas is Magnetic resonance imaging (MRI) which permits their classification into four categories based on their radiological appearance. According to the World Health Organization (WHO) classification, the majority of spinal meningiomas are grade 1. Nevertheless, they can be of higher grade (grades 2 and 3) with atypical or malignant histology and a more aggressive course. To date, surgery is the best treatment where the big majority of meningiomas can be cured. Advances in surgical techniques (ultrasonic dissection, microsurgery, intraoperative monitoring) increase the complete resection rate. Operated patients have a satisfactory prognosis, even in those with poor preoperative neurological status. Adjuvant therapy has a growing role in treating spinal meningiomas, mainly in the case of subtotal resection and tumor recurrence. The current paper reviews the fundamental epidemiological and clinical aspects of spinal meningiomas, their histological and genetic characteristics, and their management, including the various surgical novelties and techniques.

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“…Physiologic hemodynamic and cardiovascular changes that occur during pregnancy, including increased plasma volume and cardiac output, may facilitate meningioma growth [28]. As meningiomas are generally benign and slow growing, those that are identified during pregnancy but associated with low symptom burden may be simply monitored, while surgery can be considered if symptomatic [29 ▪▪ ]. Surgery after pregnancy is more frequent in cases involving headache, visual loss, or progesterone-receptor positive meningioma.…”

Section: Meningiomamentioning

confidence: 99%

Clinical management of brain tumors in pregnancy

Karbhari

Thomas

2022

Current Opinion in Oncology

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Purpose of reviewWe review the diagnostic tools, treatment options, and clinical management for brain tumors diagnosed in pregnancy with consideration for management approaches that are best suited to preserve maternal and fetal health.Recent findingsWomen of child-bearing age are at risk of developing brain tumors and are at increased risk compared with male counterparts for tumors that are hormonally driven. Brain tumors are rare neoplasms, and diagnosis of brain tumors in pregnancy is uncommon, such that management guidelines and treatment recommendations are lacking for most tumor types. We discuss the standard treatment options for brain tumors and the relative risks and safety when these treatments are considered during pregnancy. We review the neoplasms most commonly affecting pregnant women and the existing literature and guidelines.SummaryPregnancy is a unique phase of life in which hormonal, immunologic, and vascular changes may impact tumor growth and presentation. Treatment decisions should consider the symptoms and stability of the pregnant patients, the gestational age and health of the fetus, and the location and behavior of the neoplasm.

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Meningioma during pregnancy: what can influence the management? A case series and review of the literature

Cited by 7 publications

References 64 publications

Use of progestogens and the risk of intracranial meningioma: national case-control study

Use of progestogens and the risk of intracranial meningioma: national case-control study

Spinal meningiomas, from biology to management - A literature review

Clinical management of brain tumors in pregnancy

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