Acoustic neuroma in the pregnant patient

Magliulo, Giuseppe; Ronzoni, R.; Petti, R.; Marcotullio, Dario; Marini, Mario

doi:10.1007/bf00168034

Cited by 9 publications

(6 citation statements)

References 3 publications

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“…The strategy and planning of the neurosurgical and obstetrical moves may be crucial. Few similar cases have been described previously (9, 25, 31, 32). In the past, prognosis in such cases was very poor (9, 25).…”

Section: Discussionsupporting

confidence: 62%

Huge acoustic neurinomas presenting in the late stage of pregnancy

Beni‐Adani¹,

Pomeranz²,

Flores³

et al. 2001

Acta Obstet Gynecol Scand

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Section: Discussionsupporting

confidence: 62%

Huge acoustic neurinomas presenting in the late stage of pregnancy

Beni‐Adani¹,

Pomeranz²,

Flores³

et al. 2001

Acta Obstet Gynecol Scand

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“…The optimal treatment strategy for both mother and fetus is close observation, followed by tumor resection after delivery. 1,4,5,10,11 The second-best strategy is delivery of the infant (if late enough in the third trimester), immediately followed by tumor resection. 5 Cesarian delivery is the preferred method due to the risk of increased intracranial pressure during phase 2 of vaginal delivery.…”

Section: General Principles Of Managementmentioning

confidence: 99%

“…Intracranial neoplasms rarely present in pregnant women, and diagnosis and management of these tumors during this time poses a significant challenge. 1,2 We describe a patient who presented with a large vestibular schwannoma during her second trimester. We review the literature on similar reported cases, summarize the management strategies according to the stage of pregnancy, and present a treatment algorithm that considers the patient's stage of pregnancy and neurologic status.…”

Section: Introductionmentioning

confidence: 99%

Large Vestibular Schwannomas Presenting during Pregnancy: Management Strategies

Shah

Chamoun

2014

J Neurol Surg B

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Objective?Large vestibular schwannomas rarely present in pregnant women. Diagnosis and management of these tumors during pregnancy present a therapeutic challenge. Methods?A 20-year-old primigravida woman at 26 weeks' gestation was transferred to our facility with gait imbalance, left facial weakness, left ear hearing loss, and recent nausea and vomiting. Magnetic resonance imaging revealed a large left cerebellopontine angle mass with extension into the left internal auditory canal and compression of the fourth ventricle resulting in mild hydrocephalus. The patient was admitted with a plan for early delivery at 32 weeks followed by tumor resection. One week later, the patient's headache and neurologic symptoms worsened due to increased hydrocephalus; a ventriculoperitoneal shunt was placed. The next day, an emergent cesarean delivery was performed due to worsening respiratory status. Four days later, a tracheostomy and percutaneous endoscopic gastrostomy tube were placed due to dysphagia. Eight days after the delivery, the mass was resected with a left retrosigmoid approach without complications. Immunohistochemistry confirmed vestibular cellular schwannoma on cranial nerve VIII showing unusually high mitotic activity. Results?The patient was discharged to inpatient rehabilitation on postoperative day 12 without new neurologic deficit. At 1?month, the patient was swallowing without aspiration. Her facial sensation had returned, her facial weakness remained stable, and her gait was significantly improved. Conclusion?If the patient is neurologically stable, the best option is to delay resection until after delivery. If resection is necessary during pregnancy, the optimal time is during the second trimester.

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“…7 Other intriguing evidence for a hormonal influence on tumor growth emerges from studies in which preservation of preoperative hearing after VS resection was less likely for premenopausal women than for men or postmenopausal women. 8 It has long been speculated that pregnancy stimulates the growth of VS. Several published reports in the literature describe the infrequent presentation of pregnant patients with VS. 9 VS are statistically more frequent in women, and larger, more vascular tumors are twice as common in women. 10 Since nausea, vomiting, headaches and vertigo are common complaints both during pregnancy and in the presence of brain tumors, though intracranial lesions are rare, it is possible that they may be under-diagnosed or even missed in the pregnant patient until neurological deficits appear.…”

Section: Introductionmentioning

confidence: 95%

“…Other intriguing evidence for a hormonal influence on tumor growth emerges from studies in which preservation of preoperative hearing after VS resection was less likely for premenopausal women than for men or postmenopausal women 8 . It has long been speculated that pregnancy stimulates the growth of VS. Several published reports in the literature describe the infrequent presentation of pregnant patients with VS 9 . VS are statistically more frequent in women, and larger, more vascular tumors are twice as common in women 10 .…”

Section: Introductionmentioning

confidence: 99%

Vestibular Schwannoma Quantitative Polymerase Chain Reaction Expression of Estrogen and Progesterone Receptors

et al. 2008

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Objectives/Hypothesis Determine the role of estrogen receptor (ER) and progesterone receptor (PR) expression in sporadic and neurofibromatosis 2 (NF2)-related vestibular schwannomas (VS). Growth and proliferation signaling in human VS tumorigenesis may play a key role in molecular therapeutic targeting. VS carry mutations of the NF2 gene encoding the tumor suppressor, merlin, which interacts with ErbB2 in Schwann cells, implicating ErbB receptors in VS tumorigenesis. ErbB receptor family members are overexpressed or constitutively activated in many human tumors, and are effective therapeutic targets in some human cancers. VS occur more frequently in women and are larger, more vascular, and demonstrate increased growth rates during pregnancy. ER and PR may play a role in ErbB pathway activation and VS progression. Study Design Quantitative real-time polymerase chain reaction (qRT-PCR) for ER and PR messenger RNA was performed using greater auricular and vestibular nerve controls (n = 8), sporadic VS (n = 23), and NF2-related VS (n = 16) tissues. Methods The qRT-PCR data were normalized with standardization to a single constitutively expressed control gene, human cyclophylin. Results Reverse transcription of messenger RNA from control and tumor specimens followed by RT Q-PCR demonstrated differences in ER and PR gene expression between sporadic and NF2-related VS. Conclusions ER and PR expression in VS might have implications for development of a VS-specific drug delivery system using antihormone and ErbB pathway small molecule inhibitors, due to crosstalk between these receptors. These signals may be critical for re-establishing ErbB-mediated cell density dependent growth inhibition.

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Acoustic neuroma in the pregnant patient

Abstract: We report the case history of a 24-year-old woman with an acoustic neuroma diagnosed during the 24th week of pregnancy. Diagnostic steps and surgical management of this uncommon condition, which represents a therapeutic challenge, are discussed.

Cited by 9 publications

References 3 publications

Huge acoustic neurinomas presenting in the late stage of pregnancy

Huge acoustic neurinomas presenting in the late stage of pregnancy

Large Vestibular Schwannomas Presenting during Pregnancy: Management Strategies

Vestibular Schwannoma Quantitative Polymerase Chain Reaction Expression of Estrogen and Progesterone Receptors

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