Commentary

The incidence of brain tumor is not different in a pregnant lady as compared to other women of her age. During pregnancy meningiomas, pituitary adenomas, hemangioblastomas, vestibular schwannomas become more symptomatic. When a brain tumor develops during pregnancy, the symptoms of brain tumor can be exacerbated because of increased tumor growth or edema, increased vascularity, or pregnancy-related immunotolerance. The presences of estrogen and progesterone receptors in meningiomas make them more vulnerable to grow rapidly during pregnancy. There can be accelerated growth of meningioma during pregnancy resulting in rapid deterioration of neurological status requiring urgent neurosurgical intervention. Administration of anesthesia and performing a major neurosurgical procedure during pregnancy is challenging. Neurological outcome of expectant mother and fetus have to be given priority depending on the gestational period. During the first trimester fetus deserves priority. Any intervention or medication should be postponed till the period of embryogenesis is over to reduce the risk of fetal loss and congenital malformations. Seizures should be controlled, preferably with monotherapy and should be supplemented with folic acid. During mid-trimester surgery can be safely performed on mother. The authors should be congratulated for successfully managing the case at 30th week of gestation. The clinical features and imaging findings are not detailed and hence the urgency of intervention cannot be determined. Meningiomas are associated with cerebral edema which can be treated with medications. Unless the life or neurological function of mother is at risk, surgery should be deferred till the age of fetal viability. Though there are no guidelines for management of brain tumor during pregnancy, during the last trimester after determining the fetal maturity, elective delivery of the fetus should be done (preferably through Caesarean section if the woman has signs of raised intracranial pressure) and then tumor should be excised.