The occurrence of brain tumours during pregnancy is unusual, when this happen jeopardises the lives of both the mother and infant. This article aims at identifying the best medical management to be followed for a pregnant patient harbouring a brain tumour. The records of 10 patients with brain tumours diagnosed during pregnancy were retrospectively examined. The histological diagnosis revealed 3 grade 2 astrocytomas, and 1 grade 2 oligodendroglioma. All this gliomas (100%) developed dedifferentiation in the mean period of 27 months. The histology of the others tumours were 2 grade 1 meningiomas, 1 melanoma metastasis, 1 epidermoid tumour, 1 case of chemodectoma and 1 patient with a pituitary apoplexy in a non-function adenoma. There was no operative mortality in these series, and no fetal deaths were observed. Prior to craniotomy, five patients had caesarean sections, two others had vaginal deliveries. In three patients the delivery took place after the brain tumour treatment. Two patients had vaginal delivery and eight caesarean sections. The best moment to recommend the craniotomy and the neurosurgical removal of the tumour will depend of the mother's neurological condition, the tumour histological type as well as the gestational age. A multi-disciplinary approach was used to determine the optimal management for each patient.

RESUMO -O diagnóstico de um tumor cerebral durante a gravidez é um fato raro que coloca a mãe e o concepto em risco de vida. Objetivo: Avaliar a melhor forma de conduzir uma paciente grávida portadora de um tumor cerebral. Método: Realizamos análise retrospectiva dos prontuários e imagens de seis pacientes grávidas portadoras de tumor cerebral. Resultados: Vários tipos histológicos de tumor cerebral podem estar associados à gravidez. O meningioma é o mais freqüente. Nessa série não observamos óbito cirúrgi-co materno. Em duas pacientes, o parto ocorreu antes da craniotomia e em outras quatro o parto foi realizado após a neurocirurgia. Conclusão: O momento mais adequado para a realização da craniotomia para remoção tumoral irá depender da gravidade do quadro neurológico, do tipo histológico presumível da lesão, e da idade gestacional do embrião. PALAVRAS-CHAVE: gravidez, tumor cerebral, meningioma, microneurocirurgia. Brain tumors and pregnancyABSTRACT -Background: Despite not being a common fact, the occurrence of brain tumors during pregnancy poses a risk to both the mother and infant. Aim: To identify the best medical procedure to be followed for a pregnant patient harboring a brain tumor. Method: The records of 6 patients with brain tumors, diagnosed during pregnancy were examined. Results: Several types of brain tumors have been associated with pregnancy, but the meningioma is, by far, the most frequent. It seems that pregnancy aggravates the clinical course of intracranial tumors. There were no operative mortality in these series. In 2 patients the labor occurred before the craniotomy and in others, the delivery occurred after the surgery. Conclusion: The best moment to recommend the craniotomy and the neurosurgical removal of the tumor will depend of the mother's neurological condition, the tumor histological type as well as the gestational age. RJ -Brasil. E-mail: cneuroamericas@uol.com.br O diagnóstico de um tumor cerebral durante a gravidez é um evento extremamente raro [1][2][3][4][5][6][7][8][9][10][11] . Dr. José Carlos Lynch -Rua Jardim Botânico 600 / 605 -22461-000 Rio de JaneiroO surgimento de um tumor cerebral durante uma gestação coloca a mãe e concepto em risco de vida 4,7,10,11 , e também suscita dilemas de ordem neurocirúrgica, clínica, obstétrica, ética e psicológica. A utilização de uma abordagem multidisciplinar para essas pacientes é fundamental porque se está lidando com pacientes que se encontram em um momento crítico de suas vidas, quando ocorrem profundas mudanças orgânicas e psíquicas.Analisamos seis casos de nossa experiência. MÉTODOEntre os anos de 1996 e 2005, 6 mulheres que se encontravam no período gestacional e com o diagnóstico de tumor cerebral foram tratadas no Serviço de Neurocirurgia do Hospital dos Servidores do Estado (HSE), no Rio de Janeiro.As pacientes também foram acompanhadas pelos serviços de obstetrícia, psicologia e anestesia que discutiram entre si e determinaram, juntamente com as famílias e as pacientes, as condutas que foram instituídas. Todos os pós-oper...

Background:Despite the development of microsurgery and cranial base techniques, the surgical management of Foramen Magnum Meningiomas (FMM) continues to be a technical challenge to neurosurgeons. Controversy concerning the utility of systematic condyle drilling for approaching FMM has been raised. Our aim was to describe the surgical technique, analyze its safety, and the postoperative outcome in 12 consecutive FMM patients.Methods:From 1986 to 2011, 12 patients with FMM underwent operations in the Department of Neurosurgery at Servidores do Estado Hospital and in a private clinic. All patients were operated using a standard suboccipital craniectomy, preserving the occipital condyle, opening of the Foramen Magnum, and ipsilateral removal of the posterior arch of C1.Results:There was no operative mortality, nine patients achieved Glasgow Outcome Scale 4 or 5. Condylar resection was not deemed necessary in any case. Gross total resection was achieved in nine patients. After surgery, four patients developed lower cranial nerve weakness. There was no significant postoperative complication in the remaining patients. The average follow-up is 8.2 years.ConclusionThe vast majority of FMM can be safely removed with a retrocondylar lateral suboccipital approach without condylar resection, using meticulous microsurgical techniques.