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Craniotomy for suprasellar meningioma in a 28-week pregnant woman without fetal heart rate monitoring

La craniotomie pour un méningiome suprasellaire chez une femme enceinte de 28 semaines, sans monitorage de la fréquence cardiaque fœtale

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Abstract

Purpose

To illustrate the anesthetic management of a craniotomy for suprasellar meningioma in a 28-week pregnant woman and to review the considerations for fetal monitoring during surgery.

Clinical features

A 33-yr-old woman presented at 28 weeks of gestation with rapidly deteriorating vision in her right eye. Neuroradiological investigations revealed a large suprasellar meningioma extending into the frontal lobe. She underwent a craniotomy for excision of the tumour at 28 weeks gestation because of the risk of irreversible blindness. Anesthetic management was tailored for pregnancy and an intracranial tumour. Intraoperative blood pressure was maintained within 10% of baseline and respiratory variables were stable. No fetal heart rate monitoring was used during the surgery, as there was no plan to perform an emergency Cesarean delivery even in the event of change in fetal monitoring. The aim was to treat the mother aggressively for any untoward events. She made a good neurological recovery after the procedure and had a spontaneous vaginal delivery at 40 weeks of gestation without any neonatal complications.

Conclusions

Anesthetic management of a brain tumour during pregnancy should be tailored to the individual patient according to the circumstances. It is possible to perform this type of procedure without fetal heart rate monitoring. The decision regarding fetal monitoring should be based on the consensus of the multidisciplinary care team and the mother.

Résumé

Objectif

Illustrer la composante anesthésique d’une craniotomie pour méningiome suprasellaire chez une femme enceinte de 28 semaines et revoir ce qui justifie l’usage du monitorage fœtal peropératoire.

Éléments cliniques

Une femme de 33 ans a consulté à 28 semaines de grossesse pour une rapide détérioration de la vision à l’œil droit. Les examens neuroradiologiques ont révélé un important méningiome suprasellaire s’étendant dans le lobe frontal. Étant donné le risque de cécité irréversible, l’excision de la tumeur a été réalisée lors d’une craniotomie d’urgence. L’anesthésie a été planifiée en fonction de la grossesse et de la tumeur intracrânienne. La tension artérielle peropératoire a été maintenue dans les limites de 10% des conditions initiales et les variables respiratoires ont été stables. Le monitorage peropératoire de la fréquence cardiaque fœtale n’a pas été utilisé, car on n’avait pas planifié de césarienne d’urgence, même dans l’éventualité de changement au monitorage fœtal. L’objectif était un traitement rigoureux de la mère quoiqu’il arrive. La récupération neurologique a été bonne et suivie d’un accouchement par voie vaginale à 40 semaines, sans complications néonatales.

Conclusion

Le programme anesthésique de l’excision d’une tumeur cérébrale pendant la grossesse doit s’adapter à la patiente et aux circonstances. On peut réaliser ce type d’opération sans le monitorage fœtal. Mais c’est une décision qui doit être fondée sur un consensus de l’équipe multidisciplinaire de soignants et de la mère.

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Author information

Correspondence to Pirjo H. Manninen.

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Balki, M., Manninen, P.H. Craniotomy for suprasellar meningioma in a 28-week pregnant woman without fetal heart rate monitoring. Can J Anesth 51, 573–576 (2004). https://doi.org/10.1007/BF03018400

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Keywords

  • Meningioma
  • Fetal Heart Rate
  • Anesthetic Management
  • Spontaneous Vaginal Delivery
  • Rapid Sequence Induction