Article
Neurosurgical challenges: intracranial urgencies and emergencies during pregnancy
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Published: | June 9, 2017 |
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Objective: Obstetric causes of maternal mortality have been reduced over the past few years. Intracranial pathologies, however, may cause special problems when they become manifest during pregnancy. With regard to the hormonal, haemodynamic and anatomical changes during pregnancy, certain neurosurgical pathologies are particularly challenging and standard neurosurgical procedures might be inappropriate. Here, we present our experience in the surgical management of intracerebral pathologies during pregnancy.
Methods: Data of pregnant women who underwent surgery for intracranial pathologies within the period from 2005-2015 were collected and analysed.
Results: Nine pregnant women underwent a neurosurgical procedure within the study period. Maternal mean age was 35.4 years. Five women presented with intracrainal haemorrhage (epidural haematoma (1), arteriovenous malformation (1), subarachnoid haemorrhage (2) and intracerebral haemorrhage (1)). The other four patients suffered from meningoleiomyosarkoma, cystic trigeminal schwannoma, anaplastic astrocytoma and glioblastoma. Mean gestational age at the time of bleeding was 31.1 weeks. Cesarean section was the mode of delivery in seven patients which resulted in live-born fetuses. In one woman, who suffered intracranial bleeding at week 18 of gestational age of the fetus, spontaneous abortion occurred. One infant was delivered spontaneously in gestational week 40. Development was unremarkable in all infants. All women underwent surgery for their intracranial pathology prior or after delivery of the fetus. Five women survived, while four women succumbed to the intracranial pathology.
Conclusion: Pregnant women with intracranial pathologies need a coordinated interdisciplinary approach to support the mother to deliver a viable and healthy child, and to timely approach the lesion. While contemporary care might insure survival for the majority of infants, maternal mortality still poses an extraordinary challenge.