Tuberculum Sellae Meningiomas in Pregnancy: 3 Cases Treated in the Second Trimester and Literature Review.

Publication Title

World Neurosurg

Authors

Regin Jay Mallari, Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, California, USA
Jai Deep Thakur, Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, California, USA; John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, USAFollow
Chester Griffiths, Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, California, USA; John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, USAFollow
Howard Krauss, Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, California, USAFollow
Amy Eisenberg, Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, California, USAFollow
Garni Barkhoudarian, Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, California, USA; John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, USAFollow
Daniel F Kelly, Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, California, USA; John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, USAFollow

Document Type

Article

Publication Date

8-3-2020

Keywords

Bitemporal hemianopsia; Endoscopic endonasal surgery; Keyhole craniotomy; Pregnancy; Supraorbital craniotomy; Tuberculum sellae meningioma; Vision loss

Abstract

BACKGROUND: Tuberculum sella meningiomas typically present with progressive visual loss. It is also known that meningiomas can become symptomatic during pregnancy. Herein we report on 3 patients who presented with progressive visual decline during pregnancy, prompting urgent surgical removal of their meningiomas.

CASE DESCRIPTIONS: From our prospectively collected brain tumor database, all women surgically treated for tuberculum sella meningioma since 2006 were retrospectively reviewed. Clinical presentation, surgical approach, perioperative management, and pathology of pregnant patients were reviewed and compared with those of the nonpregnant cohort. Of 43 women with newly diagnosed tuberculum sella meningioma, 3 (7%) presented in pregnancy with progressive visual loss, 1 in the late first trimester and 2 in the early second trimester. One woman pregnant with twins had a broad-based meningioma and underwent a supraorbital craniotomy and gross total tumor removal in her second trimester. Two women with singleton pregnancies both underwent endoscopic endonasal gross total tumor removal during their second trimesters. All 3 patients had visual recovery, 2 of which were complete, and all went on to have successful uncomplicated deliveries of their children and maintain normal pituitary gland function.

CONCLUSIONS: Presentation of tuberculum sella meningioma during pregnancy is uncommon but not rare, accounting for 7% of women in our series. Ideally, surgery is performed in the second trimester, ensuring fetal safety while restoring maternal vision and maintaining pituitary gland function are essential. Depending on tumor size and sellar anatomy, endoscopic endonasal or supraorbital keyhole craniotomy approaches are both viable options.

Clinical Institute

Neurosciences (Brain & Spine)

Clinical Institute

Women & Children

Specialty/Research Institute

Obstetrics & Gynecology

Specialty/Research Institute

Neurosciences

Specialty/Research Institute

Oncology