Intracranial Meningioma Diagnosed during Pregnancy Caused Maternal Death

Abstract

Brain tumors are rarely diagnosed during pregnancy. Accelerated growth of intracranial meningiomas during pregnancy sometimes requires urgent surgical intervention. We describe a 41-year-old pregnant woman with severe neurological decompensation requiring immediate neurosurgery. Cesarean section resulted in maternal death. Meningioma diagnosed during a viable pregnancy should be managed according to the severity of maternal neurological symptoms and gestational age of pregnancy. Early intervention for intracranial tumors during pregnancy may save maternal and fetal lives.

Unique presentation of giant multiple meningiomas during immediate postpartum, case report and review of literature

“…The reported incidence of intracranial tumors in pregnant women is approximately 7 x 125,000 pregnancies, being the glioma the first in frequency, 4,8 and specifically in the case of meningiomas, the incidence is of 1-4.5 per 100,000 pregnancies.…”

“…5,9 Meningiomas can grow during pregnancy, especially in its second half. 4 The mechanisms involved are not fully understood and the present factors are, among others, fluid retention, intraand extracellular edema, vessel congestion, increased vascularity, increased body mass index (BMI) 3 and increased hormones, especially prolactin and estrogen. 5,4,10 Meningiomas express receptors for different hormones, among them: androgens, progesterone, estrogen, placental growth factor and others.…”

“…11 Therefore, as it has been reported in the literature, tumor size and symptoms may decline after birth. 4 Kerschbaumer et al 9 Reported a 39-week pregnancy case with a 5cm sphenoidal meningioma, elective surgery was scheduled two months after birth and the tumor reduced its size by 50%. Meningiomas sensitive to hormones may shrink after delivery.…”

Frontal lobe meningioma mimicking preeclampsia: A case study

“…Ideally, multidisciplinary management with the anaesthetists and neurosurgeons is advised to determine the induction of anaesthesia process and delivery timing in the presence of a raised ICP and altered medical condition of the patient. [5][6][7] However, due to the rarity of the condition in pregnancy, obstetric and anaesthetic management needs to be individualised based on the location and size of the tumour and the medical condition and gestational age of the woman.…”

“…5 They can also present with seizures, visual impairments, hemiparesis, mood changes and confusion. 3–7 This patient had severe headaches and nausea, which were initially attributed to preeclampsia.…”