Case 66 - Anestheticmanagement of pregnant patients with brain tumors

Summary

Physiologic changes during pregnancy may result in the development or growth of nervous system tumors. Brain tumors tend to become larger during pregnancy due to fluid retention, increased blood volume, and hormonal changes. If the patient is stable, gestational advancement may be permitted into the early second trimester, where surgical management of the tumor can be undertaken. In a patient with worsening symptoms, radiotherapy may be an option to delaying surgery. Patients should be premedicated with a nonparticulate antacid and ranitidine to protect against the sequelae of vomiting and aspiration. Cesarean section in patients with neurologic risk factors. Mechanisms of anesthesia-induced neurotoxicity and selectivity of anesthesia-induced neurodegeneration are actively being investigated. Management of brain tumors in pregnant women is mainly reliant on case reports and inherited wisdom. Therefore, close communication among the neurosurgeon, neuroanesthesiologist, obstetrician, and patient is of paramount importance.