Carbone Luigi, Somma Teresa, Iorio Giuseppe Gabriele, Vitulli Francesca, Conforti Alessandro, Raffone Antonio, Bove Ilaria, Pagano Serena, Pontillo Martina, Carbone Ilma Floriana, Farina Antonio, Maruotti Giuseppe Maria, Maiuri Francesco, Cappabianca Paolo, Alviggi Carlo
Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy.
Department of Public Health, School of Medicine, Federico II University, Naples, Italy.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):8767-8777. doi: 10.1080/14767058.2021.2004585. Epub 2021 Nov 25.
Meningioma is a benign tumor, more frequent in female population. During pregnancy, distinguishing a meningioma from other common conditions presenting with similar symptoms (headache, vomiting, visual impairment) is challenging. Moreover, the management must consider not only maternal but also fetal health. The rarity of the condition does not allow to define the features to which look in order to stratify the risk for the need of surgery during pregnancy. We reported three cases of meningioma in pregnant women treated at our department and reviewed those previously reported in the literature. The aim of this review is to evaluate which factors are more determinant in such management. Electronic databases were searched from year 2000 until June 2020, to identify clinical studies on management of meningioma diagnosed during pregnancy. The primary outcome was surgical timing. Secondary outcomes were delivery methods, maternal and neonatal outcomes. Surgery after pregnancy is more frequently performed in PR + tumor (-value 0.038) and with HA (-value 0.0445), as well as in meningioma diagnosed during the third trimester, compared to those diagnosed before (-value 0.0012). Surgery during pregnancy was more frequent in patients with visual loss (-value 0.006). No significant differences were found in surgical management, according to age, WHO grade, tumor location, lesion diameter and ER positivity. Delivery method is independent from both hormonal receptor status and main symptoms, but women who had neurosurgery during pregnancy delivered more frequently with spontaneous vaginal delivery (-value <0.01). The decision regarding surgical timing of meningioma diagnosed during pregnancy depends on PR + and impending symptoms as visual loss or headache. It seems that timing of neurosurgery does not affect the delivery method. A multidisciplinary approach is always useful to perform a rapid and appropriate diagnosis and to better evaluate pros and cons of surgery during pregnancy and following management both for maternal and fetal wellness.
脑膜瘤是一种良性肿瘤，在女性人群中更为常见。在怀孕期间，将脑膜瘤与其他具有相似症状（头痛、呕吐、视力障碍）的常见病症区分开来具有挑战性。此外，治疗方案不仅要考虑母体健康，还要考虑胎儿健康。由于该病症较为罕见，因此无法确定用于对孕期手术需求风险进行分层的观察特征。我们报告了在我们科室接受治疗的三例孕妇脑膜瘤病例，并回顾了先前文献中报道的病例。本综述的目的是评估哪些因素在这种治疗中更具决定性。检索了2000年至2020年6月的电子数据库，以确定关于孕期诊断的脑膜瘤治疗的临床研究。主要结局是手术时机。次要结局是分娩方式、母体和新生儿结局。与妊娠前诊断的脑膜瘤相比（P值为0.0012），PR阳性+肿瘤（P值为0.038）、伴有头痛（P值为0.0445）以及在妊娠晚期诊断出的脑膜瘤，更常采用产后手术。视力丧失的患者在孕期进行手术更为频繁（P值为0.006）。根据年龄、世界卫生组织分级、肿瘤位置、病变直径和雌激素受体阳性情况，手术治疗方面未发现显著差异。分娩方式与激素受体状态和主要症状均无关，但在孕期接受神经外科手术的女性更常采用自然阴道分娩（P值<0.01）。孕期诊断的脑膜瘤手术时机的决定取决于PR阳性和即将出现的症状，如视力丧失或头痛。神经外科手术时机似乎不影响分娩方式。多学科方法对于快速、准确地诊断以及更好地评估孕期手术的利弊以及后续对母体和胎儿健康的管理始终是有用的。
