College of Medicine, The Ohio State University, Columbus, Ohio, USA.
Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA; Department of Otolaryngology Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
World Neurosurg. 2018 May;113:e373-e382. doi: 10.1016/j.wneu.2018.02.038. Epub 2018 Feb 14.
Neoplasms rarely present during pregnancy; however, increases in plasma volume, hormone release-induced growth, and tumor hypervascularity can cause rapidly progressive symptoms of varying severity, ranging from those not requiring intervention to those necessitating emergent operations. Here we describe an algorithm for the management of symptomatic neoplasms in the obstetric population and provide recommendations for surgical indications and timing.
Patients who presented to the skull base clinic at a large tertiary care hospital between 2010 and 2016 were reviewed to identify those who presented with a skull base tumor during pregnancy.
Our study cohort comprised 9 women with a skull base tumor during pregnancy. Four patients presented with symptoms that necessitated emergent skull base surgery, and 5 underwent surgery after delivery or were followed with continued surveillance. All operated patients had a World Health Organization grade I or II meningioma or schwannoma. There were no maternal complications. Based on our experience with this cohort, we have created a management algorithm.
Management of a symptomatic tumor during pregnancy requires balancing the potential for curing the mother and the risk of harming the fetus. Trimester of pregnancy is the most critical factor in evaluating the need for urgent management. The second trimester is the optimal time for surgery, associated with the lowest risk for spontaneous abortion or preterm birth. The first and third trimesters are associated with increased risk of miscarriage and preterm labor, respectively. Induction of labor for preterm delivery, followed by surgery, may be appropriate in the early third trimester. Regardless of the perceived risk, however, all pregnant women with an emergent presentation should be offered surgery, regardless of trimester.
肿瘤在妊娠期间很少出现；然而，血浆体积增加、激素释放诱导生长和肿瘤高血管性可导致严重程度不同的快速进展症状，从不需要干预到需要紧急手术不等。在这里，我们描述了一种管理产科人群中症状性肿瘤的算法，并提供了手术指征和时机的建议。
回顾 2010 年至 2016 年间在一家大型三级保健医院的颅底诊所就诊的患者，以确定在妊娠期间出现颅底肿瘤的患者。
我们的研究队列包括 9 名在妊娠期间患有颅底肿瘤的女性。4 名患者出现需要紧急颅底手术的症状，5 名患者在分娩后接受手术或继续接受随访。所有接受手术的患者均患有世界卫生组织（WHO）I 级或 II 级脑膜瘤或神经鞘瘤。没有发生母体并发症。根据我们对这组患者的经验，我们制定了一种管理算法。
妊娠期间有症状肿瘤的管理需要平衡治愈母亲和伤害胎儿的风险。妊娠的孕龄是评估紧急管理需求的最关键因素。妊娠中期是手术的最佳时机，与自发性流产或早产的风险最低相关。妊娠早期和晚期分别与流产和早产的风险增加相关。对于早产，可进行引产，随后在妊娠晚期进行手术。然而，无论感知到的风险如何，所有出现紧急情况的孕妇都应接受手术，无论孕龄如何。
