Anaesthetic management of a pregnant patient with intracranial space occupying lesion for craniotomy

Marulasiddappa, Vinay; Raghavendra, B. S.; Nethra, H N

doi:10.4103/0019-5049.147170

Cited by 9 publications

(5 citation statements)

References 9 publications

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“…Intracranial tuberculomas are rare in pregnant patients, yet they remain an important differential diagnosis for intracranial space-occupying lesions, particularly in areas with a higher prevalence of tuberculosis 25,26 . The absence of active TB can lead to misinterpretation of tuberculoma symptoms as indicative of tumors.…”

Section: Discussionmentioning

confidence: 99%

Cerebral tuberculoma in pregnant women: A systematic review and comprehensive analysis of literature

Vinueza,

Rebellón-Sánchez,

Llanos

et al. 2024

Preprint

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This systematic review and descriptive analysis examines the diagnostic and management complexities of cerebral tuberculomas in pregnant women, a condition that is infrequent and characterized by a wide spectrum of symptoms resembling those of other neurological diseases. We analyzed data from 26 cases across 16 countries between 1975 and 2024, highlighting the clinical manifestations, diagnostic strategies—including diverse interpretations of histopathological, imaging, and laboratory findings—and treatment options for tuberculomas during pregnancy. The absence of comprehensive guidelines for managing this condition underscores the urgent need for specialized knowledge and research in this area, aiming to improve outcomes for both pregnant women and their products of gestation.

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Section: Discussionmentioning

confidence: 99%

Cerebral tuberculoma in pregnant women: A systematic review and comprehensive analysis of literature

Vinueza,

Rebellón-Sánchez,

Llanos

et al. 2024

Preprint

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“…[ 13 ] Among them, neurosurgery presents substantial challenges to anesthesiologists and requires appropriate changes in management plans before operation. [ 14 ] To accomplish this, it is vital to consider both the patient herself and the unborn fetus in utero . Therefore, our goal was to maintain the pregnancy, ensure the patient safety, and achieve the best possible outcome for the fetus.…”

Section: Discussionmentioning

confidence: 99%

Neurosurgical anesthesia for a pregnant woman with macroprolactinoma

Xia

Griffiths

et al. 2018

Medicine

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Rationale:Being required to perform neurosurgery on a pregnant woman is rare, but occasionally unavoidable. In these cases, clinical anesthesiologists are confronted with conflicting information and few evidence-based guidelines.Patient concerns:Here, we describe the successful anesthetic management of a 24-week pregnant woman with macroprolactinoma who underwent endonasal transsphenoidal resection of pituitary adenoma.Diagnoses:According to the prolactin (PRL) level and magnetic resonance imaging (MRI) results, the patient was diagnosed with macroprolactinoma and kept stable after taking the regular bromocriptine treatment. However, after stopping the drug by herself because of pregnancy, her tumor increased in size and she suffered from vision loss. Surgery was recommended as soon as possible to lessen the compression in the eye. However, the anesthetic management was a considerable risk due to the increased chance of maternal mortality, intrauterine growth restriction, or preterm labor.Interventions:We held a multidisciplinary meeting before the operation and made a detailed plan for how to proceed. During the operation, our team ensured intensive monitoring, provided adequate oxygen, and achieved haemodynamic stability. Anesthetics like sufentanyl, rocuronium, propofol, and desflurane were carefully chosen in order to ensure the safety of both the mother and fetus.Outcomes:Under the careful and successful anesthetic management, the pregnant woman underwent the surgery smoothly and neither the mother nor baby experienced any pre- or postoperative complications. At the 38th week of gestation, the patient received a cesarean section and the baby had developed normally.Lessons:Neurosurgeries in pregnancy are sparse, and careful planning with cross-disciplinary specialists was needed in advance of the operation. Moreover, when dealing with such surgeries, we should consider the safety of both the mother and fetus, which is challenging but important.

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“…The ongoing pregnancy complicates the tumor by predisposing to edema formation due to increased nitric oxide production and increased perfusion [12]. On the other hand, neurosurgical intervention puts the fetus under risk as anaesthesia and surgery can result in fetal hypoxemia, trigger preterm labour and thus the complications of prematurity [13]. Smooth rapid sequence induction of anaesthesia, fluid maintenance and blood pressure monitoring with or without tocolytics are advised [12,13].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy with Meningioma: Report of Two Rare Cases

Ravi¹,

Sachdeva²,

Gandhi³

et al. 2017

JCR

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Background: Meningioma in pregnancy is a rare occurrence. Whenever it is accompanied with pregnancy, it is mostly symptomatic with complaints like headache, vomiting, visual disturbance, seizures or altered sensorium. The management is challenging as the fetal well-being is also affected along with complications of raised intracranial pressure during labour. Case Report: Here we discuss two such cases of meningioma in third trimester. One was frontal meningioma with intact neurological functions. On the other hand, second patient had a left sphenoid meningioma with left optic atrophy and right hemiparesis. Both of them underwent cesarean delivery under general anesthesia. However, the neurosurgical excision of meningioma was accompanied with the delivery in the second case as the situation demanded the same. Conclusion: These cases always warrant a multimodality approach involving obstetrician, neonatologist, anaesthetist and neurosurgeon. The timing of delivery or neurosurgery depends on the clinical situation like fetal maturity, neurological condition, progress of symptoms and patients' wishes.

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Anaesthetic management of a pregnant patient with intracranial space occupying lesion for craniotomy

Cited by 9 publications

References 9 publications

Cerebral tuberculoma in pregnant women: A systematic review and comprehensive analysis of literature

Cerebral tuberculoma in pregnant women: A systematic review and comprehensive analysis of literature

Neurosurgical anesthesia for a pregnant woman with macroprolactinoma

Pregnancy with Meningioma: Report of Two Rare Cases

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