Vestibular Schwannoma growth during pregnancy

Abstract

Background: Acoustic neuromas are a common sequela of neurofibromatosis type 2 and have been shown to grow at an increased rate during pregnancy.Case: 21-year-old female, gravida 1 para 0, with history of neurofibromatosis type 2 presented for prenatal care following new onset seizures and progressive deafness. She was found to have bilateral slow-growing acoustic neuromas. Over the course of her pregnancy, her acoustic neuroma began growing and she became completely deaf. She underwent surgical decompression during her pregnancy and had a late preterm vaginal delivery due to preeclampsia with severe features. She subsequently had further operative and medical treatment of her neuromas. Conclusion:Acoustic neuromas during pregnancy are exceedingly rare, but can be managed successfully with an interdisciplinary team approach tailored to the patients' specific clinical presentation.

Large vestibular schwannomas presenting in the late state of pregnancy: a case report and literature review

“…The best time to remove the tumor before delivery is in the middle of pregnancy when the possibility of fetal malformation or miscarriage due to anesthetic drugs is minimal, and the hormonal levels and hemodynamics of the mother have not significantly changed (3,9,21,22). It has been suggested that removal of the tumor in mid-pregnancy may be considered for patients presenting with obstructive hydrocephalus and progressive neurological deterioration (23).…”

“…Additionally, in previous cases of pregnancy with VS, the tumor also tended to be large (>4 cm; Table 1). As a result of the "irrigation effect" of estrogen on VS during pregnancy, the tumor often progresses rapidly and is frequently diagnosed at a large size (3,8,9). Certain patients who are diagnosed with a vestibular schwannoma during the initial stages of pregnancy choose conservative observation.…”

“…Certain patients who are diagnosed with a vestibular schwannoma during the initial stages of pregnancy choose conservative observation. However, it has been observed that the neuroma may exhibit rapid growth during pregnancy, leading to the exacerbation of symptoms in the later stages of pregnancy (9,10). Additionally, VS patients in late pregnancy are at great risk for the smooth administration of anesthesia, fetal protection, cesarean section, and tumor removal.…”