Neurosurgical Issues in Pregnancy

Can, Anil; Du, Rose

doi:10.1055/s-0037-1607430

Cited by 13 publications

(7 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a multidisciplinary discussion between neurosurgeons and obstetricians, we judged digital subtraction angiography and subsequent embolization as reasonable, considering the deterioration of retrograde leptomeningeal venous drainage due to the increase in cardiac output in the third trimester of a twin pregnancy. 1,2,5 Under the informed consent of the patient for our treatment strategy, we performed the procedure on day 28 2/7 weeks of gestation.…”

Section: History and Examinationmentioning

confidence: 99%

“…As to intracranial aneurysms and cerebral arteriovenous malformations, many reports in the literature have discussed how the risk of hemorrhage changes and how to deal with the disease during pregnancy. 1,2 In contrast, less is known about the relationship between pregnancy and dural arteriovenous fistulae (DAVF). Several literature reviews have suggested that pregnancy potentially triggers the formation of DAVF.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Embolization of dural arteriovenous fistula during twin pregnancy – A case report and literature review

et al. 2021

View full text Add to dashboard Cite

Background Several literature reviews have suggested that pregnancy may trigger the formation of dural arteriovenous fistulae (DAVF). However, few case reports have described DAVF discovered during pregnancy, and treatment strategies remain largely unknown. Case description: A 28-year-old primigravid woman without any medical history of note presented to our hospital for natural twin conception. She started to feel left-sided pulsatile tinnitus in 23 weeks of gestation. Magnetic resonance imaging of the head raised suspicion of left cavernous sinus DAVF with leptomeningeal venous drainage. Considering the risk of intracerebral hemorrhage due to the increased cardiac output in the third trimester of a twin pregnancy, we performed transarterial embolization for the DAVF, which was successfully achieved without complications in 28 weeks of gestation. Tinnitus resolved immediately after the procedure, and the postoperative course proved uneventful. Both fetuses were safely delivered by cesarean section on 37 1/7 weeks of gestation. Conclusions We encountered a case of cavernous sinus DAVF during a twin pregnancy. This case suggests that hemodynamic shift due to pregnancy has potential to cause higher shunt flow in an arteriovenous fistula. The timing of treatment should be determined in consideration of the hemodynamic change in the course of pregnancy. If X-ray exposures and iodine contrast media are appropriately managed, endovascular intervention is one treatment option, even during pregnancy.

show abstract

Section: History and Examinationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Embolization of dural arteriovenous fistula during twin pregnancy – A case report and literature review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…However, the unique risks related to pregnancy were not addressed in that trial. Conservative management is usually recommended in the absence of intracranial hemorrhage, although some experts recommend preemptive treatment given the special risks of pregnancy (97). In patients with high-risk features including deep location and drainage, arteriovenous fistula, or concomitant aneurysm, the timing of any planned intervention should be decided on an individualized basis (18).…”

Section: Management Of Hemorrhagic Stroke In Pregnancymentioning

confidence: 99%

“…Delaying interventions or diagnostic testing due to fear of possible radiation or contrast effects has proven to be detrimental for mother and the fetus (56,98). To date, most evidence has shown no increased rupture of cerebral aneurysms during pregnancy, and conservative treatment of unruptured aneurysms is recommended in most cases (97).…”

Section: Management Of Hemorrhagic Stroke In Pregnancymentioning

confidence: 99%

Maternal Stroke: an Update

Zambrano

Miller

2019

Curr Atheroscler Rep

View full text Add to dashboard Cite

Purpose of the review: Maternal morbidity and mortality is rising in the United States, and maternal stroke is a major contributor. Here, we review the epidemiology, risk factors and current recommendations for diagnosis and acute treatment of ischemic and hemorrhagic stroke during pregnancy and postpartum, focusing on recent evidence. Recent findings:The incidence of maternal stroke has risen in recent years, possibly due to increasing rates of hypertensive disorders of pregnancy. The risk of maternal stroke is highest in the peripartum and early postpartum period. Preeclampsia is highly associated with reversible cerebral vasoconstriction syndrome and posterior reversible encephalopathy syndrome, and is also associated with long-term increased risk of stroke and vascular dementia. Hypertensive disorders of pregnancy, migraine, and infections are risk factors for maternal stroke. Limited data suggest that thrombolytics and endovascular reperfusion therapy are safe and effective in pregnant women with ischemic stroke, but few data are available regarding safety of thrombolytics in the postpartum period. New consensus guidelines are now available to assist with management of ischemic and hemorrhagic stroke in pregnancy.Summary: Many gaps remain in our understanding of maternal stroke. While risk factors have been identified, there are no prediction tools to help identify which women might be at highest risk for postpartum stroke and require closer monitoring. The risk of recurrent maternal stroke has not been adequately quantified, limiting clinicians' ability to counsel patients. The complex pathophysiology of preeclampsia and its effects on the cerebral vasculature require further targeted study. An increased focus on the prevention, recognition, and optimal treatment of maternal stroke will be critical to reducing maternal morbidity and mortality.

show abstract

“…However, there are multiple reports of high blood pressure and bleeding from arteriovenous malformations or cerebral aneurysm. [ 4 ] If caesarean delivery is recommended from the outset, spinal anaesthesia appears to suit the objectives of appropriate care, as it avoids risky intubation in pregnancy and allows for good neurological monitoring. [ 2 5 ] Coagulation must be carefully monitored during the entire process, as it could be a risk factor for cerebral bleeding.…”

mentioning

confidence: 99%