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Endocrine

, Volume 66, Issue 3, pp 477–484 | Cite as

Multidisciplinary team efforts improve the surgical outcomes of sellar region lesions during pregnancy

  • Hui Ping Zhong
  • Hao Tang
  • Yong Zhang
  • Yan Luo
  • Hong Yao
  • Yu Cheng
  • Wei Ting Gu
  • Yong Xu Wei
  • Zhe Bao WuEmail author
Endocrine Surgery
  • 62 Downloads

Abstract

Purpose

Treatment of space-occupying lesions (SOLs) in the sellar region is a clinical challenge, especially in pregnant women because many treatment decisions are restrained due to pregnancy. We attempt to discuss the surgical indications and timing for pregnant patients and highlight the importance of multidisciplinary team (MDT) treatment.

Methods

From August 2017 to February 2018, four pregnant women were admitted to our hospital with severe visual impairment due to sellar region SOLs, including two cases of tuberculum sellae meningioma, one case of giant pituitary adenoma and one case of a pituitary abscess. All four patients were safely treated by surgery during the second and third trimesters of pregnancy through concerted efforts of the MDT, including a neurosurgeon as the team leader in combination with experts in obstetrics, ophthalmology and endocrinology.

Results

The SOLs were removed completely from all four patients, resulting in significantly improved vision without operation-related complications. Pregnancy continued postoperatively to full-term delivery in three of the four patients. The other patient with a pituitary abscess selected to terminate the pregnancy at a gestational age of 20 weeks because of her own concerns. The four babies (including a pair of twins) were born healthy and had developed normally at the 6-week postpartum follow-up.

Conclusions

With the MDT guiding the decision-making process, surgical resection of sellar region SOLs in pregnant women with severe visual impairment is practical to improve the prognosis without affecting the outcomes of pregnancy for either the mother or the infant.

Keywords

Multidisciplinary team (MDT) Pregnancy Sellar region lesion Visual impairment 

Notes

Funding

This study was funded by Shanghai Science and Technology Commission and Program of Shanghai Academic Research Leader (ZBW) (grant number: 18XD1403400).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    W. Saeger, D.K. Ludecke, M. Buchfelder, R. Fahlbusch, H.J. Quabbe, S. Petersenn, Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur. J. Endocrinol. 156(2), 203–216 (2007).  https://doi.org/10.1530/eje.1.02326 CrossRefPubMedGoogle Scholar
  2. 2.
    H.C. Kim, S.G. Kang, P.W. Huh, S. Yoo do, K.S. Cho, D.S. Kim, Pituitary abscess in a pregnant woman. J. Clin. Neurosci. 14(11), 1135–1139 (2007).  https://doi.org/10.1016/j.jocn.2006.03.012 CrossRefPubMedGoogle Scholar
  3. 3.
    S. Shitara, N. Nitta, T. Fukami, K. Nozaki, Tuberculum sellae meningioma causing progressive visual impairment during pregnancy. Neurol. Med Chir. 52(8), 607–611 (2012)CrossRefGoogle Scholar
  4. 4.
    O.E. Idowu, M.T. Shokunbi, S.D. Amanor-Boadu, O.A. Roberts, C. Eyo, Surgical management of tuberculum sellae meningioma in a patient with a twin pregnancy: case report. Surg. Neurol. 62(1), 60–63 (2004).  https://doi.org/10.1016/j.surneu.2003.07.007 CrossRefPubMedGoogle Scholar
  5. 5.
    E. Grillo-Mallo, J. Jimenez-Benito, E. Diez-Feijoo, I. Alonso Alonso, A. Ferrero Collado, S. Munoz Quinones, [Acute visual loss in pregnancy caused by craniopharyngioma]. Arch. Soc. Esp. Oftalmol. 89(4), 152–156 (2014).  https://doi.org/10.1016/j.oftal.2012.09.016 CrossRefPubMedGoogle Scholar
  6. 6.
    A. Tandon, J. Alzate, P. LaSala, M.P. Fried, Endoscopic endonasal transsphenoidal resection for pituitary apoplexy during the third trimester of pregnancy. Surg. Res Pract. 2014, 397131 (2014).  https://doi.org/10.1155/2014/397131 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    B.H. Priddy, B.A. Otto, R.L. Carrau, D.M. Prevedello, Management of skull base tumors in the obstetric population: a case series. World Neurosurg. 113, e373–e382 (2018).  https://doi.org/10.1016/j.wneu.2018.02.038 CrossRefPubMedGoogle Scholar
  8. 8.
    M. Zoli, M. Faustini-Fustini, D. Mazzatenta, E. Pasquini, G. Frank, Tuberculum sellae meningioma growing during pregnancy: a difficult decision-making process. J. Clin. Endocrinol. Metab. 97(5), 1418–1419 (2012).  https://doi.org/10.1210/jc.2012-1155 CrossRefPubMedGoogle Scholar
  9. 9.
    P. Witek, G. Zielinski, M. Maksymowicz, W. Zgliczynski, Transsphenoidal surgery for a life-threatening prolactinoma apoplexy during pregnancy. Neuro Endocrinol. Lett. 33(5), 483–488 (2012)PubMedGoogle Scholar
  10. 10.
    S. Moscovici, S. Fraifeld, J.E. Cohen, S. Dotan, U. Elchalal, Y. Shoshan, S. Spektor,, Parasellar meningiomas in pregnancy: surgical results and visual outcomes. World Neurosurg. 82(3–4), e503–e512 (2014).  https://doi.org/10.1016/j.wneu.2013.06.019 CrossRefPubMedGoogle Scholar
  11. 11.
    E. Lioret, P. Francois, C. Hommet, [Tumors of the neuraxis and neuraxial sheaths during pregnancy (excluding tumors of the sellar region)]. Neurochirurgie 46(2), 76–87 (2000)PubMedGoogle Scholar
  12. 12.
    C. Zoia, A. Cattalani, E. Turpini, V.M. Custodi, M. Benazzo, F. Pagella, P. Carena, E. Lovati, P. Lucotti, P. Gaetani, Haemorrhagic presentation of a craniopharyngioma in a pregnant woman. Case Rep. Neurol. Med. 2014, 435208 (2014).  https://doi.org/10.1155/2014/435208 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    B. Vizner, J. Talan-Hranilovic, Z. Gnjidic, M. Sekso, M. Berkovic, V. Altabas, Z. Rumboldt, Lymphocytic adenohypophysitis simulating a pituitary adenoma in a pregnant woman. Coll. Antropol. 26(2), 641–650 (2002)PubMedGoogle Scholar
  14. 14.
    S. Sakatsume, T. Kawataki, M. Ogiwara, H. Sato, H. Kinouchi, [Spontaneous improvement in visual symptom after delivery in a case of tuberculum sellae meningioma]. No Shinkei Geka 46(7), 607–613 (2018).  https://doi.org/10.11477/mf.1436203777 CrossRefPubMedGoogle Scholar
  15. 15.
    J.G. Chacko, J.L. Miller, E.J. Angtuaco, Spontaneous postpartum resolution of vision loss caused by a progesterone receptor-positive tuberculum sellae meningioma. J. Neuroophthalmol. 30(2), 132–134 (2010).  https://doi.org/10.1097/WNO.0b013e3181da9d59 CrossRefPubMedGoogle Scholar
  16. 16.
    D. Grkovic, T. Bedov, [Outcome of visual acuity after surgical removal of pituitary adenomas]. Srp. Arh. Celok. Lek. 141(5–6), 296–303 (2013)CrossRefGoogle Scholar
  17. 17.
    A. Atmaca, S. Dagdelen, T. Erbas, Follow-up of pregnancy in acromegalic women: different presentations and outcomes. Exp. Clin. Endocrinol. Diabetes 114(3), 135–139 (2006).  https://doi.org/10.1055/s-2005-873004 CrossRefPubMedGoogle Scholar
  18. 18.
    F.H. Ebner, A. Bornemann, H. Wilhelm, U. Ernemann, J. Honegger, Tuberculum sellae meningioma symptomatic during pregnancy: pathophysiological considerations. Acta Neurochir. 150(2), 189–193 (2008).  https://doi.org/10.1007/s00701-007-1417-5. discussion 193CrossRefPubMedGoogle Scholar
  19. 19.
    E.M. Kasper, P.E. Hess, M. Silasi, K.H. Lim, J. Gray, H. Reddy, L. Gilmore, B. Kasper, A pregnant female with a large intracranial mass: reviewing the evidence to obtain management guidelines for intracranial meningiomas during pregnancy. Surg. Neurol. Int 1, 95 (2010).  https://doi.org/10.4103/2152-7806.74242 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    J. Pallud, H. Duffau, R.A. Razak, P. Barbarino-Monnier, L. Capelle, D. Fontaine, M. Frenay, F. Guillet-May, E. Mandonnet, L. Taillandier, Influence of pregnancy in the behavior of diffuse gliomas: clinical cases of a French glioma study group. J. Neurol. 256(12), 2014–2020 (2009).  https://doi.org/10.1007/s00415-009-5232-1 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Hui Ping Zhong
    • 1
  • Hao Tang
    • 2
  • Yong Zhang
    • 2
  • Yan Luo
    • 3
  • Hong Yao
    • 2
  • Yu Cheng
    • 4
  • Wei Ting Gu
    • 2
  • Yong Xu Wei
    • 2
  • Zhe Bao Wu
    • 2
    Email author
  1. 1.Department of Obstetrics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
  2. 2.Department of Neurosurgery, Center of Pituitary TumorRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
  3. 3.Department of Anesthesiology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
  4. 4.Department of Ophthalmology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina

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