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Management strategies for acute brain lesions presenting during pregnancy: a case series.
MedLine Citation:
PMID:  21344977     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background. The management of brain lesions diagnosed during pregnancy is challenging to both obstetricians and neurosurgeons. In this study, a series of nine pregnant women were admitted to neurosurgery presenting with different acute brain lesions. Objective. To establish guidelines for the management of acute brain lesions that present during pregnancy. Patients and methods. Retrospective review of the medical records of all pregnant women admitted for urgent care to King Khalid University Hospital (KKUH) from 1995 to 2009. Results. Eight patients were multiparous, and one was primigravida, two were in the first trimester, and seven were in the second or third trimester. The mean age was 30.5 years. Six patients had brain tumours, while one patient had tuberculoma, and two had aneurismal subarachnoid haemorrhages (SAH). Three patients completed a full term pregnancy following surgery. Two patients had emergency caesarean section (CS) immediately followed by neurosurgery in the same session. Two patients completed their pregnancies to full term and had craniotomies after delivery. Two patients had therapeutic abortions followed by neurosurgery. No maternal or foetal complications were recorded in this series. Conclusion. The management of pregnant patients with acute brain lesions should be individualised and multidisciplinary. As it is difficult to allocate a single, general treatment protocol to pregnant patients with brain lesions, we suggest the following guidelines: for patients in the second and early third trimesters, it is safe to perform a craniotomy first and allow the patient to complete a full term pregnancy. For patients at 34 weeks or more of gestation, emergency CS followed by a craniotomy is recommended. For patients in the 1st trimester, it is advisable to terminate the pregnancy to allow safe management, although the laws governing this will vary from country to country. For patients with benign tumours who respond to corticosteriods, it is possible to complete the pregnancy and postpone surgery until after delivery.
Authors:
Sherif Elwatidy; Zain Jamjoom; Essam Elgamal; Ahmed Abdelwahab
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-23
Journal Detail:
Title:  British journal of neurosurgery     Volume:  -     ISSN:  1360-046X     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8800054     Medline TA:  Br J Neurosurg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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