Maternal Neurosurgical Management of Central Nervous System Tumors During Pregnancy: A Case Series with Long-Term Offspring Neurodevelopmental Follow-Up.

Abstract

This study aims to evaluate treatment strategies for maternal central nervous system (CNS) tumors during pregnancy and their effect on the long-term fetal neuromotor development. The clinical and radiological characteristics of these lesions were analyzed throughout the gestational and postpartum periods. Nine pregnant women with symptomatic intradural CNS tumors were included in this study. We recorded surgical timing, hospital stay length, anesthesia exposure details, maternal-fetal outcomes, and the neuromotor status of the offspring. Neuromotor follow-up was assessed using the Ankara Developmental Screening Inventory Test for children under 6 years old and the Wechsler Intelligence Scale-IV for those older than 6 years. Of the 8 operated CNS tumors, 3 huge malignant brain tumors (gliosarcoma, high-grade glioma, and multiple myeloma metastasis) were operated during pregnancy. The other 3 brain tumors and 2 spinal tumors (high-grade glioma, meningioma, pituitary neuroendocrine tumor, myxopapillary ependymoma, cervical schwannoma) were operated after delivery. One with symptomatic pituitary neuroendocrine tumor was treated conservatively. No maternal or fetal mortality was observed in our series. Disseminated intravascular coagulation occurred as a major complication, with an incidence of 12.5% among operated CNS tumors. Mental-motor retardation was not observed and preterm children (<34 weeks) had borderline cognitive scores. CNS tumors during pregnancy require multidisciplinary strategies that prioritize both maternal and fetal safety. Our neurosurgical interventions, whether performed during gestation or after delivery, were not associated with early maternal or fetal mortality in our cohort. Prematurity before 34 gestational weeks were observed to be associated with borderline cognitive scores in young ages.