Waack Andrew L, Lucarelli Vito M, Marellapudi Amulya, Gega Alisa, Zillgitt Andrew J, Staudt Michael D
Division of Neurosurgery, Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
Department of Neurology, Beaumont Neuroscience Center, Royal Oak, MI, USA.
Case Rep Neurol. 2024 Jul 17;16(1):196-203. doi: 10.1159/000539510. eCollection 2024 Jan-Dec.
The pregnant state may cause or exacerbate existing neurological disease. Gliomas appear to be influenced by the physiological changes that occur during pregnancy. The pregnant state may also cause seizures, including status epilepticus. There are currently no defined treatment guidelines to direct clinical decision making, and many of the commonly employed therapies are contraindicated during pregnancy.
The current article describes the case of a 40-year-old G3P1101 female at 10 weeks' gestation, who sought medical care for recurrent left hemifacial twitching, eventually leading to nonconvulsive status epilepticus. Intubation and sedation were required to achieve seizure cessation. Imaging revealed a lobulated cystic mass in the right parietal lobe, suspicious for low-grade glioma. Despite thorough explanation of the potential risks, the patient adamantly wished to pursue surgical intervention. An uneventful craniotomy was performed for resection of a low-grade glioma. No patient or fetal complications were encountered, and the patient has not had any reported seizures since surgery.
Managing complex neurosurgical diseases in pregnant patients provides both clinical and ethical quandaries. We describe the successful management of a patient presenting with status epilepticus caused by an underlying glioma during pregnancy. Although challenging, favorable neurosurgical outcomes are possible during pregnancy.
妊娠状态可能引发或加重现有的神经系统疾病。胶质瘤似乎会受到孕期发生的生理变化的影响。妊娠状态还可能引发癫痫发作，包括癫痫持续状态。目前尚无明确的治疗指南来指导临床决策，而且许多常用疗法在孕期是禁忌的。
本文描述了一名妊娠10周、孕3产1101的40岁女性病例，该患者因反复左侧半面肌抽搐就医，最终发展为非惊厥性癫痫持续状态。为了终止癫痫发作，需要进行插管和镇静。影像学检查显示右侧顶叶有一个分叶状囊性肿块，怀疑为低级别胶质瘤。尽管已向患者详细解释了潜在风险，但患者坚决希望进行手术干预。为切除低级别胶质瘤进行了一次顺利的开颅手术。未出现任何患者或胎儿并发症，自手术以来患者未再有癫痫发作的报告。
处理妊娠患者的复杂神经外科疾病会带来临床和伦理方面的难题。我们描述了一名孕期因潜在胶质瘤导致癫痫持续状态的患者的成功治疗过程。尽管具有挑战性，但孕期仍可能获得良好的神经外科治疗结果。
