Wijaya Olivia Josephine, Ardiansyah Djohan
Department of Neurology, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, Indonesia.
Ann Med Surg (Lond). 2022 Apr 22;77:103647. doi: 10.1016/j.amsu.2022.103647. eCollection 2022 May.
Meningioma is the second most common primary brain tumor. There are approximately 5.6 cases of meningioma per 100,000 pregnant women. Foramen magnum meningioma is rare, and the diagnosis, treatment, and prognosis are complex in pregnant women.
Herein, we report a case of foramen magnum meningioma in a pregnant woman at 32 weeks of gestation, who presented with chronic neck pain and cervical myelopathy. She tested positive for COVID-19 infection. Magnetic resonance imaging findings were compatible with foramen magnum meningioma, and the pathologic analysis revealed a WHO grade-I meningioma. The patient underwent cesarean section followed by tumor excision due to fetal distress and rapid deterioration.
Management of meningioma during pregnancy requires a multidisciplinary approach. No guidelines for surgical intervention, timing of pregnancy termination, or mode of delivery for pregnant patients with foramen magnum meningioma have been established. While it is best to prolong the pregnancy for as long as possible, a cesarean delivery is preferred to avoid increased intracranial pressure. Operative management of meningioma is warranted if the tumor is growing or symptomatic. This patient died due to the added complication of COVID-19. Although the prognosis of foramen magnum meningioma is usually favorable, COVID-19 comorbidity can increase illness severity.
Maternal and fetal health status must be evaluated to decide whether surgical excision and pregnancy termination are needed. In this case, COVID-19 infection and meningioma disease course required further investigation.
脑膜瘤是第二常见的原发性脑肿瘤。每10万名孕妇中约有5.6例脑膜瘤病例。枕骨大孔脑膜瘤罕见，其在孕妇中的诊断、治疗及预后较为复杂。
在此，我们报告一例妊娠32周孕妇的枕骨大孔脑膜瘤病例，该孕妇表现为慢性颈部疼痛和颈髓病。她的新冠病毒感染检测呈阳性。磁共振成像结果与枕骨大孔脑膜瘤相符，病理分析显示为世界卫生组织一级脑膜瘤。由于胎儿窘迫和病情迅速恶化，患者先接受了剖宫产，随后进行了肿瘤切除。
孕期脑膜瘤的管理需要多学科方法。对于患有枕骨大孔脑膜瘤的孕妇，尚未制定手术干预、终止妊娠时机或分娩方式的指南。虽然最好尽可能延长孕期，但剖宫产更可取，以避免颅内压升高。如果肿瘤在生长或出现症状，则有必要对脑膜瘤进行手术治疗。该患者因新冠病毒感染的附加并发症死亡。尽管枕骨大孔脑膜瘤的预后通常良好，但合并新冠病毒感染会增加疾病严重程度。
必须评估母婴健康状况，以决定是否需要手术切除和终止妊娠。在本病例中，新冠病毒感染和脑膜瘤病程需要进一步研究。
