Pereira Celestino Esteves, Lynch Jose Carlos
Neurosurgical and Obstetrics Departments of Servidores do Estado Hospital, RJ, Brazil.
Surg Neurol Int. 2017 Feb 20;8:27. doi: 10.4103/2152-7806.200575. eCollection 2017.
The occurrence of a brain tumor or intracranial vascular lesion during pregnancy is a rare event, but when it happens, it jeopardizes the lives of both the mother and infant. It also creates challenges of a neurosurgical, obstetric, and ethical nature. A multidisciplinary approach should be used for their care.
Between 1986 and 2015, 12 pregnant women diagnosed with brain tumors and 17 women with intracranial vascular lesion underwent treatment at the Neurosurgery Department of the Servidores do Estado Hospital and Rede D'Or/São Luis. The Neurosurgery Department teamed up with Obstetrics Anesthesiology Departments in establishing the procedures. The patients' records, surgical descriptions, imaging studies, and histopathological material were reviewed.
Among 12 patients presenting with brain tumors, there were neither operative mortality nor fetal deaths. Among the vascular lesions, aneurysm rupture was responsible for bleeding in 6 instances. Arteriovenous malformation was diagnosed in 7 patients. In this subgroup, the maternal and fetal mortality rates were 11.7% and 23.7%, respectively.
We can assert that the association between a brain tumor and vascular lesions with pregnancy is a very unusual event, which jeopardizes both the lives of the mother and infant. It remains incompletely characterized due to the rare nature of these potentially devastating events. Knowing the exact mechanism responsible for the interaction of pregnancy and with these lesions will improve the treatment of these patients.
孕期发生脑肿瘤或颅内血管病变是罕见事件，但一旦发生，会危及母婴生命。这也带来了神经外科、产科及伦理方面的挑战。对其治疗应采用多学科方法。
1986年至2015年间，12例诊断为脑肿瘤的孕妇和17例患有颅内血管病变的女性在Servidores do Estado医院和Rede D'Or/São Luis医院的神经外科接受治疗。神经外科与产科麻醉科合作制定治疗程序。回顾了患者的病历、手术描述、影像学研究和组织病理学资料。
12例脑肿瘤患者中，无手术死亡病例，也无胎儿死亡。在血管病变中，动脉瘤破裂导致6例出血。7例患者诊断为动静脉畸形。在这个亚组中，孕产妇和胎儿死亡率分别为11.7%和23.7%。
我们可以断言，脑肿瘤和血管病变与妊娠之间的关联是非常罕见的事件，会危及母婴生命。由于这些潜在毁灭性事件罕见，其特征仍不完全明确。了解妊娠与这些病变相互作用的确切机制将改善对这些患者的治疗。
