Neurosurgical interventions during pregnancy

Czech version

Authors: B. Musilová ¹; M. Štoková ¹; P. Košťál ^1,2; J. Fiedler ^1,3
Published in: Cesk Slov Neurol N 2024; 87(2): 96-100
Category: Review Article
doi: https://doi.org/10.48095/cccsnn202496

Overview

Neurosurgical illnesses or disorders are rare in pregnancy. Vascular pathologies, intracranial tumors, traumatic brain injury or disc herniation are the most common. Recognition of clinical signs, diagnosis and follow-up treatments can be difficult to manage regarding pregnancy. Vomiting or headache are typical symptoms for both pregnancy as well for increased intracranial pressure. As part of the diagnosis, we should avoid excess usage of radiological examinations. Therapeutic guidelines have not been clearly established; therefore, they are based only on retrospective studies or case reports. In our review article, we present the most common neurosurgical pathologies in pregnancy and their treatment.

Keywords:

pregnancy – neurosurgery in pregnancy – intracranial pathologies

Sources

1. Wu J, Ma YH, Wang TL. Glioma in the third trimester of pregnancy: two cases and a review of the literature. Oncol Lett 2013; 5 (3): 943–946. doi: 10.3892/ol.2013.1106.

2. Westrhenen van A, Senders JT, Martin E et al. Clinical challenges of glioma and pregnancy: a systematic review. J Neurooncol 2018; 139 (1): 1–11. doi: 10.1007/s11060-018-2851-3.

3. Ardaillon H, Laviv Y, Arle JE et al. Lumbar disk herniation during pregnancy: a review on general management and timing of surgery. Acta Neurochir 2017; 160 (7): 1361–1370. doi: 10.1007/s00701-017-3098-z.

4. Shiro R, Murakami K, Miyauchi M et al. Management strategies for brain tumors diagnosed during pregnancy: a case report and literature review. Medicina (Kaunas) 2021; 57 (6): 613. doi: 10.3390/medicina57060613.

5. Ng J, Kitchen N. Neurousurgery and pregnancy. J Neurol Neurosurg Psychiatry 2008; 79 (7): 745–752. doi: 10.1136/jnnp.2007.117002.

6. Qaiser R, Black P. Neurosurgery in pregnancy. Semin Neurol 2007; 27 (5): 476–481. doi: 10.1055/s-2007-991129.

7. Ascanio LC, Maragkos GA, Young BC et al. Spontaneous hemorrhage in pregnancy: a systematic review of literature. Neurocrit Care 2019; 30 (1): 5–15. doi: 10.1007/ s12028-018-0501-4.

8. Laviv Y, Ohla V, Kasper EM. Unique features of pregnancy-related meningiomas: lessons learned from 148 reported cases and theoretical implications of a prolactin modulated pathogenesis. Neurosurg Rev 2016; 41 (1): 95–108. doi: 10.1007/s10143-016-0762-3.

9. Cohen-Gadol AA, Friedman JA, Friedman JD et al. Neurosurgical management of intracranial lesions in the pregnant patient: a 36-year institutional experience and review of the literature. J Neurosurg 2009; 111: 1150–1157. doi: 10.3171/2009.3.JNS081160.

10. American College of Obsetricians and Gynecolog- ists. Committee opinion No. 723: guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol 2017; 130 (4): e210–e216. doi: 10.1097/AOG. 0000000000002355.

11. Zidaru AM, Paslaru FG, Paslaru AC et al. Management of unruptured brain aneurysms during pregnancy and puerperium. Ro J Neurol 2022; 21 (2): 110–114. doi: 10.37897/RJN.2022.2.3.

12. Fairhall JM, Stoodley MA. Intracranial haemorrhage in pregnancy. Obstet Med 2009; 2 (4): 142–148. doi: 10.1258/om.2009.090030.

13. Aoyama K, Ray JG. Pregnancy and risk of intracerebral haemorrhage. JAMA Netw Open 2020; 3 (4): e202844. doi: 10.1001/jamanetworkopen.2020.2844.

14. Lv X, Liu Peng, Youxiang Li. Pre-existing, incidental and hemorrhagic AVMs in pregnancy and postpartum: gestational age, morbidity and mortality, management and risk to the fetus. Interv Neuroradiol 2016; 22 (2): 206–211. doi: 10.1177/1591019915622161.

15. Porras JL, Yang W, Philadelphia E et al. Hemorrhage risk of brain arteriovenous malformations during pregnancy and puerperium in a North American cohort. Stroke 2017; 48 (6): 1507–1513. doi: 10.1161/STROKEAHA.117.016828/-/DC1.

16. Nussbaum ES, Goddard JK, Davis AR. A Systematic review of intracranial aneurysms in the pregnant patient – a clinical conundrum. J Obstet Gynecol Reprod Biol 2020; 254: 79–86. doi: 10.1016/j.ejogrb.2020. 08.048.

17. Shikha G, Arun Y, Renu M et al. The oncologist’s struggle with maternal-fatal conflict. J Cancer Res Ther 2022; 18 (1): 5–18. doi: 10.4103/jcrt.JCRT_1343_20.

18. Laviv Y, Bayoumi A, Mahadevan A et al. Meningiomas in pregnancy: timing of surgery and clinical outcomes as observed in 104 cases and establishment of a best management strategy. Acta Neurochir 2018; 160 (8): 1521–1529. doi: 10.1007/s00701-017-3146-8.

19. Pallud J, Duffau H, Razak RB et al. Influence of pregnant in the behaviour of diffuse gliomas: clinical cases of a French glioma study group. J Neurol 2009; 256 (12): 2014–2020. doi: 10.1007/s00415-009-5232-1.

20. Peeters S, Pagés M, Gauchotte G et al. Interactions between glioma and pregnancy: insight from a 52-case multicenter series. J Neurosurg 2018; 128 (1): 3–13. doi: 10.3171/2016.10.JNS16710.

21. Flechl B, Hassler MR, Kopetzky G et al. Case report: pregnancy in a patient with recurrent glioblastoma. F1000Res 2013; 2: 246. doi: 10.12688/f1000research. 2-246.v1.

22. Proskynitopoulos PJ, Lam FC, Sharma S et al. A review of the neurosurgical management of brain metastases during pregnancy. Can J Neurol Sci 2012; 48 (5): 698–707. doi: 10.1017/cjn.2020.254.

23. Pantelis E, Antypas C, Frassanito MC et al. Radiation dose to the fetus during CyberKnife radiosrguery for a brain tumor in pregnancy. Phys Med 2016; 32 (1): 237–241. doi: 10.1016/j.ejmp.2015.09.014.

24. Leach MR, Zammit CG. Traumatic brain injury in pregnancy. Handb Clin Neurol 2020; 172: 51–61. doi: 10.1016/B978-0-444-64240-0.00003-9.

25. Darlan D, Budi G, Prasetya et al. Algorithm of traumatic brain injury in pregnancy (perspective on neurosurgery). Asian J Neurosurg 2021; 16 (2): 249–257. doi: 10.4103/ajns.AJNS_243_20.

26. Di Filippo S, Godoy DA, Manca M et al. Ten rules for the management of moderate and severe traumatic brain injury during pregnancy: an expert viewpoint. Front Neurol 2022; 13: 911460. doi: 10.3389/fneur.2022.911460.

27. Kho GS, Abdullah JM. Management of severe traumatic brain injury in pregnancy: a body with two lives. Malays J Med Sci 2018; 25 (5): 151–157. doi: 10.21315/mjms 2018.25.5.14.

28. Kapetanakis S, Giovannopoulo E, Blontzos N et al. Surgical management for lumbar disc herniation in pregnancy. J Gynecol Obstet Hum Reprod 2017; 46 (10): 753–759. doi: 10.1016/j.jogoh.2017.09.009.

29. Paslaru FG, Giovani A, Iancu G et al. Methods of delivery in pregnant women with lumbar disc herniation: a narrative review of general management and case report. J Med Life 2020; 13 (4): 517–522. doi: 10.25122/jml-2020-0166.

30. Kim HS, Kim SW, Lee SM et al. Endoscopic discectomy for the cauda equina syndrom during third trimester of pregnancy. J Korean Neurosurg Soc 2007; 42 (5): 419–420. doi: 10.3340/jkns.2007.42.5.419.

31. Martino AD, Russo F, Denaro L et al. How to treat lumbar disc herniation in pregnancy? A systematic review on current standards. Eur Spine J 2017; 26 (Suppl 4): 496–504. doi: 0.1007/s00586-017-5040-8.

32. Sastry R, Sufianov R, Laviv Y et al. Chiari I malformation and pregnancy: a comprehensive review of the literature to address common questions and to guide management. Acta Neurochir 2019; 162 (7): 1565–1573. doi: 10.1007/s00701-020-04308-7.