Management Strategies for Brain Tumors Diagnosed during Pregnancy: A Case Report and Literature Review

Abstract

Background and Objectives: Maternal brain tumors diagnosed during pregnancy are very rare, and their clinical course remains incompletely understood. We recently experienced a case of a brain tumor diagnosed at 30 weeks of gestation, and the treatment was initiated after delivery at 32 weeks of gestation. In this study, we reviewed case reports of brain tumors diagnosed during pregnancy, focusing on whether the brain tumor was treated during pregnancy or after termination of pregnancy and on the timing of therapeutic intervention. Materials and Methods: We searched PubMed and Ichushi-Web for articles published after January 2000 that reported cases of maternal brain tumors diagnosed during pregnancy. The patients were divided into two groups according to whether the tumor was treated during pregnancy (Group A) or after termination of pregnancy (Group B). Results: In total, 42 patients were included in the study (13 (31%) in Group A and 29 (69%) in Group B). The most common symptoms before diagnosis were those caused by increased intracranial pressure (57.1%). The diagnosis was made at 18 ± 6 weeks of gestation in Group A and 26 ± 9 weeks of gestation in Group B (p = 0.007). In all cases diagnosed after 34 weeks of gestation, termination of pregnancy was followed by treatment. Treatment was initiated within two weeks of diagnosis in 50% of patients in Group A and 30% in Group B. Conclusions: When severe symptoms caused by increased intracranial pressure last for several weeks, imaging tests should be considered. Termination of pregnancy is a good option for a brain tumor diagnosed after 34 weeks of gestation, while comprehensive treatment decisions should be made based on the severity of symptoms and the course of pregnancy in other cases.

Clinical management of brain tumors in pregnancy

“…The timing of a surgical resection of a brain tumor in pregnancy depends on the severity of neurological symptoms, the overall health and stability of the patient, the type of tumor and malignant potential, and the gestational age and viability of the fetus. For intracranial tumors identified in the third or late second trimesters, delivery of the baby at or after 34 weeks followed by initiation of treatment, including resection, has been associated with favorable maternal and fetal outcomes [11,12]. In stable patients, delivery may proceed vaginally [13], but for unstable patients needing urgent neurosurgical decompression, cesarean section may be recommended.…”

Managing Central Nervous System Tumors During Pregnancy

“…Whereas infiltrative gliomas can be asymptomatic or present with seizures, higher-grade gliomas more commonly present with progressive symptoms of increased intracranial pressure. 16,17 These symptoms are most common in glioblastomas and should prompt brain imaging. In adults, standard treatment for glioblastoma has been maximal safe surgical resection followed by radiation and temozolomide chemotherapy.…”

“…Pregnancy is characterized by the production and regulation of various hormones and serum immune and growth factors as well as by vascular, hemodynamic, and structural body changes. 4,16 Multiple patient case series have reported that although pregnancy does not confer a higher risk for incidence of brain tumors, pregnancy is associated with worsening aggressive tumor behavior. 4,[12][13][14][15][16][17] Clarifying the impact of the full pregnancy state on brain tumor oncogenicity remains a challenge.…”

“…56,61 It is important to discuss risks for pregnancy maintenance and to involve multidisciplinary experts to ensure the patient understands options for pregnancy termination and risks to future fertility. 4,5,16 Of course, with routine clinical monitoring, stable patients could undergo elective neurosurgery or defer surgery until after delivery. 56…”

“…4 Furthermore, the optimal time for systemic clearance of these therapies before conception is controversial, and current recommendations vary between 4 and 6 months. 5,16 The use of immune-directed therapies in atopic illnesses during pregnancy was evaluated as early as the 1970s, and these therapies were reported to have limited negative effects on fetal outcomes. 64 Promising newer immunotherapies, specifically the immune checkpoint inhibitors, are currently being evaluated for use in newly diagnosed or recurrent CNS tumors as part of several ongoing clinical trials [65][66][67] ; however, pregnancy remains an exclusion criterion for enrollment in these trials.…”