Maternal and infant outcomes after elective neurosurgery for occupying lesions in saddle area during pregnancy

Abstract

Objective To investigate the perinatal outcomes after elective neurosurgery in pregnant women complicated by space-occupying lesions in saddle area. Methods Clinical data were retrospectively collected and analyzed from five gravidas with space-occupying lesions in saddle area, who underwent neurosurgery at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2017 to February 2018, including gestational age, perioperative management, surgical procedures, postoperative complications, pregnancy outcomes and pathological results. Results (1) Progressively deteriorated impaired vision was the chief complaint of all five patients. Space-occupying lesions in saddle area were detected by cranial MRI (plain scan). The surgical indication was clear as there was compression on optic nerve and a risk of blindness due to optic nerve atrophy. Two patients were operated in the third trimester and three in the second trimester. Postoperative pathology showed there were two cases with meningioma, two with pituitary macro adenoma and one with abscess of pituitary. Only one patient had mild postoperative cerebrospinal fluid rhinorrhea, which was improved three months later, and no complications were reported in the other four cases. All five patients had obvious improvement of vision after surgical intervention and no relapse was reported during a follow-up of 4-12 months. (2) Four gravidas continued their pregnancies to full or nearly full term, among which three underwent cesarean section due to obstetrical indications (one breech pregnancy, one twin pregnancy with scarred uterus and one complicated by hypertensive diseases of pregnancy with poor blood pressure control) and one delivered vaginally. Postpartum involution of the uterus was well in all of the four cases 42 d after delivery. The women with pituitary abscess terminated the pregnancy due to intraamniotic injection of ethacridine lactate at 20 weeks of gestation. Five neonates were all born with Apgar scores of 10 at 1, 5 and 10 min without any visible defects at birth and all grew and developed normally at 4-12 months after birth. Conclusions For gravidas with space-occupying lesions in saddle area, it is necessary to weigh the pros and cons and choose an individualized treatment plan. Resection of saddle area lesions in the second or third trimester backed by a multi-disciplinary team is a safe and feasible procedure if postponing the operation until delivery may cause irreversible or even life-threatening consequences. Key words: Pregnancy complications, neoplastic; Meningioma; Pituitary neoplasms; Neurosurgical procedures; Pregnancy outcome