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Management of Brain Tumors in Pregnancy

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Neurological Disorders in Pregnancy

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Abstract

Brain tumors during pregnancy are associated with poorer maternal and fetal outcomes, including higher rates of maternal mortality and preterm delivery. While the incidence of intracranial neoplasms is not elevated during pregnancy, several physiologic changes in the pregnant patient promote the accelerated growth of tumors including glioma, meningioma, vestibular schwannoma, pituitary adenoma, and vascular tumors. Presenting brain tumor symptoms like headache, vomiting, and seizures may be unspecific and must be differentiated from other pregnancy-related etiologies, such as hyperemesis gravidarum and eclampsia. Magnetic resonance imaging is the first-line imaging modality for pregnant patients. Principles guiding the treatment of brain tumors during pregnancy include planning the treatment around a nonpregnant patient and subsequently tailoring it to fetal needs as well as respecting maternal autonomy when maternal and fetal priorities are in conflict. Medical management options for intracranial neoplasms include corticosteroids, antiepileptic drugs, and radiotherapy, while the safety profile for chemotherapy and tumor-treating fields is more poorly understood. While several considerations must be heeded for neurosurgical resection in pregnant patients, with careful planning, maternal outcomes are comparable to patients without tumors. The development of prospective national and multinational registries is warranted to improve understanding of this rare and challenging clinical entity.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Oliver Y. Tang

  2. Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA

    Oliver Y. Tang

  3. Department of Neurological Surgery, New Jersey Medical School, Newark, NJ, USA

    James K. Liu

  4. Department of Otolaryngology-Head and Neck Surgery, New Jersey Medical School, Newark, NJ, USA

    James K. Liu

  5. Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, NJ, USA

    James K. Liu

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  1. Oliver Y. Tang
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Correspondence to James K. Liu .

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Editors and Affiliations

  1. Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Gaurav Gupta

  2. Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Todd Rosen

  3. Department of Neurology, Neurosurgery and Radiology, New York Medical College - Westchester Medical Center, Valhalla, NY, USA

    Fawaz Al-Mufti

  4. Department of Neurosurgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA

    Anil Nanda

  5. Department of Neurosurgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA

    Priyank Khandelwal

  6. Department of Neuroradiology, University Radiology, New Brunswick, NJ, USA

    Sudipta Roychowdhury

  7. Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA

    Michael S. Rallo

  8. Department of Cerebrovascular & Endovascular Neurosurgery, Rutgers - Robert Wood Johnson Medical Sc, New Brunswick, NJ, USA

    Sanjeev Sreenivasan

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Tang, O.Y., Liu, J.K. (2023). Management of Brain Tumors in Pregnancy. In: Gupta, G., et al. Neurological Disorders in Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-031-36490-7_32

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