Therapeutic strategies and challenges in the management of craniospinal tumours in pregnancy: a 10-year retrospective tertiary centre study, systematic review, and proposal of treatment algorithms

Abstract

Objectives: The study aims to evaluate therapeutic strategies in the management of craniospinal tumours in pregnant patients and the factors that influence the management along with their influence on maternal & foetal outcomes. Materials and Methods:A retrospective single-centre cohort study was performed at a tertiary neurosurgical referral centre. Pregnant patients referred to neuro-oncology multidisciplinary meeting (MDM) with craniospinal tumour were included. Ten-year patient data were collected from hospital records and neuro-oncology MDM outcomes. A systematic review was performed on the available literature in PubMed as per PRISMA guidelines. Results:Thirty-three patients were identified with a mean age of 31 years. 91%(n=30) had cranial lesions and 9%(n=3) had spinal lesions. Most of the patients had WHO Grade I/II tumours. 33.3% underwent surgery when pregnant whilst in 24.2% this was deferred until after the due date. 27.2% patients did not require surgical intervention and were followed up with serial imaging in the MDM. Left Lateral/park bench position was the preferred position for the spinal and posterior fossa lesions. Systematic review identified 26 eligible articles. Treatment algorithms are proposed addressing the therapeutic strategy for management of cranio-spinal tumours during pregnancy and the challenges for maternal and foetal outcomes were tabulated. Conclusions:Craniospinal tumours presenting in pregnancy are challenging. The surgical management needs to be tailored individually and as part of a multidisciplinary team approach. Maternal and foetal outcomes are to be considered during patient counselling.