Management of Brain Tumors in Pregnant Patients
Summary
Brain tumours during pregnancy present a unique clinical dilemma, requiring balance between maternal oncological care and foetal safety. Hormonal and vascular changes in gestation may accelerate tumour growth and exacerbate neurological symptoms such as raised intracranial pressure, seizures and focal deficits. Diagnosis relies chiefly on non-ionising imaging, notably magnetic resonance imaging without contrast, complemented by detailed neurological assessment. Management demands a multidisciplinary team encompassing neurosurgery, obstetrics, neuro-oncology and anaesthetics. Urgent surgical decompression is indicated in cases of rapid neurological decline or life-threatening mass effect, with timing tailored to gestational age and foetal viability. In more stable scenarios, conservative measures—corticosteroids to reduce cerebral oedema and carefully selected anti-seizure drugs—allow deferral of definitive surgery. Chemotherapy and radiotherapy are generally postponed until after delivery or, if necessary, administered in the second or third trimester under stringent benefit–risk evaluation. Delivery planning is individualised: elective caesarean or vaginal birth depends on neurological status, obstetric factors and tumour behaviour. This integrated approach aims to maximise maternal survival and neurological function while safeguarding foetal development, though evidence remains limited by retrospective analyses and small case series.
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Management of Brain Tumors in Pregnant Patients publication trend
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Technical terms
Glioma: A primary central nervous system tumour arising from glial cells, classified by grade to indicate aggressiveness and influence treatment choice.
Intracranial pressure: The pressure within the skull; elevation can cause headache, vomiting, visual changes and risk of brain herniation.
Magnetic resonance imaging (MRI): An imaging modality using magnetic fields and radio waves to produce detailed images of soft tissues, avoiding ionising radiation.
Corticosteroids: Anti-inflammatory drugs that reduce cerebral oedema and intracranial pressure, selected to minimise foetal exposure.
Teratogenicity: The potential of an agent to impair foetal development, crucial in choosing safe pharmacological therapies during pregnancy.
References
- Clinical challenges of glioma and pregnancy: a systematic review. Journal of Neuro-Oncology (2018).
- Management Strategies for Brain Tumors Diagnosed during Pregnancy: A Case Report and Literature Review. Medicina (2021).
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