Neurosurgical management of intracranial lesions in the pregnant patient

A 36-year institutional experience and review of the literature - Clinical article

Aaron A. Cohen-Gadol, Jonathan A. Friedman, Jennifer D. Friedman, R. Shane Tubbs, James R. Munis, Fredric B. Meyer

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Object. A review of the literature has revealed scant data related to neurosurgical treatment of gravid patients. The authors reviewed their experience with the neurosurgical treatment of pregnant women to better characterize the optimal management strategies for intracranial pathological entities in this population. Methods. Between July 1969 and July 2005, 34 patients with documented pregnancy and concomitant intracranial pathological entities were treated at the authors' institution. The average age of the gravid patients at presentation was 27 ± 6 years. Twelve patients harbored vascular and 14 patients harbored neoplastic lesions. Four gravid patients suffered from traumatic intracranial hemorrhage, 2 had primary intracerebral hemorrhage, and 2 had hydrocephalus. The medical records of these patients were reviewed to assess the outcome for the mothers and fetuses. Results. Nineteen pregnant patients (56%) underwent a neurosurgical procedure after induction of general anesthesia. Of these, 14 (74%) underwent craniotomies for clipping/resection of their lesion, 2 (10%) underwent stereotactic biopsies, and 3 (16%) underwent CSF shunting procedures. Three patients (9%) delivered by cesarean section followed by their neurosurgical procedure, and 5 (15%) underwent therapeutic abortion preoperatively to allow for radiation therapy early in their pregnancy (4 of these patients underwent surgery prior to their therapeutic abortion). Eleven patients (32%) were treated nonoperatively while pregnant, and 3 of these received their treatment after delivery. There was no operative maternal mortality or permanent morbidity. The fetuses did not suffer from any complications related to the mother's neurosurgical procedure. Conclusions. Based on the authors' experience and a review of the literature, surgery for intracranial lesions in pregnant patients is generally well tolerated by both mother and fetus. Preoperative delivery by cesarean section of term or near-term babies is reasonable. Some patients treated conservatively may deteriorate and require an operation.

Original languageEnglish (US)
Pages (from-to)1150-1157
Number of pages8
JournalJournal of Neurosurgery
Volume111
Issue number6
DOIs
StatePublished - Dec 2009

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Neurosurgical Procedures
Therapeutic Abortion
Fetus
Mothers
Cesarean Section
Traumatic Intracranial Hemorrhage
Pregnancy
Maternal Mortality
Craniotomy
Cerebral Hemorrhage
Hydrocephalus
General Anesthesia
Medical Records
Blood Vessels
Pregnant Women
Radiotherapy
Therapeutics
Morbidity
Biopsy
Population

Keywords

  • Aneurysm
  • Arteriovenous malformation
  • Delivery
  • Fetus
  • Neurosurgery
  • Pregnancy
  • Tumor

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

Neurosurgical management of intracranial lesions in the pregnant patient : A 36-year institutional experience and review of the literature - Clinical article. / Cohen-Gadol, Aaron A.; Friedman, Jonathan A.; Friedman, Jennifer D.; Tubbs, R. Shane; Munis, James R.; Meyer, Fredric B.

In: Journal of Neurosurgery, Vol. 111, No. 6, 12.2009, p. 1150-1157.

Research output: Contribution to journalArticle

Cohen-Gadol, Aaron A. ; Friedman, Jonathan A. ; Friedman, Jennifer D. ; Tubbs, R. Shane ; Munis, James R. ; Meyer, Fredric B. / Neurosurgical management of intracranial lesions in the pregnant patient : A 36-year institutional experience and review of the literature - Clinical article. In: Journal of Neurosurgery. 2009 ; Vol. 111, No. 6. pp. 1150-1157.
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abstract = "Object. A review of the literature has revealed scant data related to neurosurgical treatment of gravid patients. The authors reviewed their experience with the neurosurgical treatment of pregnant women to better characterize the optimal management strategies for intracranial pathological entities in this population. Methods. Between July 1969 and July 2005, 34 patients with documented pregnancy and concomitant intracranial pathological entities were treated at the authors' institution. The average age of the gravid patients at presentation was 27 ± 6 years. Twelve patients harbored vascular and 14 patients harbored neoplastic lesions. Four gravid patients suffered from traumatic intracranial hemorrhage, 2 had primary intracerebral hemorrhage, and 2 had hydrocephalus. The medical records of these patients were reviewed to assess the outcome for the mothers and fetuses. Results. Nineteen pregnant patients (56{\%}) underwent a neurosurgical procedure after induction of general anesthesia. Of these, 14 (74{\%}) underwent craniotomies for clipping/resection of their lesion, 2 (10{\%}) underwent stereotactic biopsies, and 3 (16{\%}) underwent CSF shunting procedures. Three patients (9{\%}) delivered by cesarean section followed by their neurosurgical procedure, and 5 (15{\%}) underwent therapeutic abortion preoperatively to allow for radiation therapy early in their pregnancy (4 of these patients underwent surgery prior to their therapeutic abortion). Eleven patients (32{\%}) were treated nonoperatively while pregnant, and 3 of these received their treatment after delivery. There was no operative maternal mortality or permanent morbidity. The fetuses did not suffer from any complications related to the mother's neurosurgical procedure. Conclusions. Based on the authors' experience and a review of the literature, surgery for intracranial lesions in pregnant patients is generally well tolerated by both mother and fetus. Preoperative delivery by cesarean section of term or near-term babies is reasonable. Some patients treated conservatively may deteriorate and require an operation.",
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AU - Tubbs, R. Shane

AU - Munis, James R.

AU - Meyer, Fredric B.

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N2 - Object. A review of the literature has revealed scant data related to neurosurgical treatment of gravid patients. The authors reviewed their experience with the neurosurgical treatment of pregnant women to better characterize the optimal management strategies for intracranial pathological entities in this population. Methods. Between July 1969 and July 2005, 34 patients with documented pregnancy and concomitant intracranial pathological entities were treated at the authors' institution. The average age of the gravid patients at presentation was 27 ± 6 years. Twelve patients harbored vascular and 14 patients harbored neoplastic lesions. Four gravid patients suffered from traumatic intracranial hemorrhage, 2 had primary intracerebral hemorrhage, and 2 had hydrocephalus. The medical records of these patients were reviewed to assess the outcome for the mothers and fetuses. Results. Nineteen pregnant patients (56%) underwent a neurosurgical procedure after induction of general anesthesia. Of these, 14 (74%) underwent craniotomies for clipping/resection of their lesion, 2 (10%) underwent stereotactic biopsies, and 3 (16%) underwent CSF shunting procedures. Three patients (9%) delivered by cesarean section followed by their neurosurgical procedure, and 5 (15%) underwent therapeutic abortion preoperatively to allow for radiation therapy early in their pregnancy (4 of these patients underwent surgery prior to their therapeutic abortion). Eleven patients (32%) were treated nonoperatively while pregnant, and 3 of these received their treatment after delivery. There was no operative maternal mortality or permanent morbidity. The fetuses did not suffer from any complications related to the mother's neurosurgical procedure. Conclusions. Based on the authors' experience and a review of the literature, surgery for intracranial lesions in pregnant patients is generally well tolerated by both mother and fetus. Preoperative delivery by cesarean section of term or near-term babies is reasonable. Some patients treated conservatively may deteriorate and require an operation.

AB - Object. A review of the literature has revealed scant data related to neurosurgical treatment of gravid patients. The authors reviewed their experience with the neurosurgical treatment of pregnant women to better characterize the optimal management strategies for intracranial pathological entities in this population. Methods. Between July 1969 and July 2005, 34 patients with documented pregnancy and concomitant intracranial pathological entities were treated at the authors' institution. The average age of the gravid patients at presentation was 27 ± 6 years. Twelve patients harbored vascular and 14 patients harbored neoplastic lesions. Four gravid patients suffered from traumatic intracranial hemorrhage, 2 had primary intracerebral hemorrhage, and 2 had hydrocephalus. The medical records of these patients were reviewed to assess the outcome for the mothers and fetuses. Results. Nineteen pregnant patients (56%) underwent a neurosurgical procedure after induction of general anesthesia. Of these, 14 (74%) underwent craniotomies for clipping/resection of their lesion, 2 (10%) underwent stereotactic biopsies, and 3 (16%) underwent CSF shunting procedures. Three patients (9%) delivered by cesarean section followed by their neurosurgical procedure, and 5 (15%) underwent therapeutic abortion preoperatively to allow for radiation therapy early in their pregnancy (4 of these patients underwent surgery prior to their therapeutic abortion). Eleven patients (32%) were treated nonoperatively while pregnant, and 3 of these received their treatment after delivery. There was no operative maternal mortality or permanent morbidity. The fetuses did not suffer from any complications related to the mother's neurosurgical procedure. Conclusions. Based on the authors' experience and a review of the literature, surgery for intracranial lesions in pregnant patients is generally well tolerated by both mother and fetus. Preoperative delivery by cesarean section of term or near-term babies is reasonable. Some patients treated conservatively may deteriorate and require an operation.

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KW - Arteriovenous malformation

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KW - Fetus

KW - Neurosurgery

KW - Pregnancy

KW - Tumor

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