Neurosurgery notes/Paediatrics/Pregnancy and Neurosurgery/Pregnancy and tumour

Pregnancy and tumour

View Details
Status
Done
logo
Parent item
Pregnancy and Neurosurgery

Pregnancy and Tumour

  • Tumour size is not increased during pregnancy, labor, or puerperium
  • Treatment should adhere to the treatment options as in nonpregnant women.
  • Optimal time to perform surgery for tumour (controversial)
    • Indication for immediate surgery
      • Delay can cause progressive neurologic deterioration and increasing risk of urgent intervention (resection and cesarean section).
    • Indication for delay surgery
      • Delay surgery if possible until after the first trimester to reduce the miscarriage risk
        • Surgery during the 2nd and 3rd trimesters surgery is considered safer
        • Significant complications of prematurity (e.g. respiratory diseases, bradycardia, necrotising enterocolitis, intraventricular haemorrhage, hypoglycaemia and feeding problems, sepsis and seizures)
  • What type of delivery
    • Elective cesarean section preterm
      • Better as inc. risk of raised ICP during the second stage of labor.
    • Vaginal delivery
      • If mom is clinically stable , risk of rapid tumor growth low, and gestational fetus is matured enough

Chemo/radiotherapy and pregnancy

  • Chemotherapy
    • A recent study summarized long-term data of children after antenatal exposure to chemotherapy (and/or radiotherapy) found a cardiac outcome equal to the general population, and no adverse effects of treatment on the general health and age-appropriate neurocognitive (IQ, attention, behavior, memory) development.
  • Radiotherapy (RT)
    • RT schedules are considered safe.
    • Estimations of the absorbed fetal dose were between 0.01 and 0.1 Gy (10-100 mGy) for patients who received whole brain RT by a 3D conformal technique
      • Many of the toxic effects will only be induced above the deterministic threshold of 0.1 Gy.
      • Most studies reporting on the administration of radiotherapy to brain tumors showed that the fetal exposure never exceeded this threshold dose.
    • Do proper shielding should always be used to further reduce the fetal dose and it is recommended to discuss treatment with a radiation physicist and to use a phantom to estimate the fetal dose as accurate as possible in order to counsel parents on the potential risks of radiation-induced toxicity.