Clinical characteristics and anesthesia management of intracranial space-occupying lesions during pregnancy: a retrospective analysis

Objective To analyze and summarize the clinical features and anesthesia management of patients with intracranial mass lesion during pregnancy. Methods We retrospectively collected 34 cases of intracranial mass lesions during pregnancy in our hospital from 2010 to 2017, and analyzed the characteristics, treatment, choice of anesthesia, and outcomes of the patients. Results A total of 34 cases of pregnant women suffered from intracranial mass lesions were enrolled in this study, and include 3 cases of pituitary adenoma, 2 cases of schwannoma, 5 cases of hemangioblastoma, 5 cases of hemangioma, 1 case of aneurysm, 1 case of dermoid cyst, 2 cases of meningioma, 1 case of neuroglial and neuronal mixed tumor, 12 cases of glioma, 1 case of medulloblastoma, and 1 case of choriocarcinoma. Regarding pregnant stages, 7 cases were in the early trimester, 13 cases in middle trimester, and 14 cases in late trimester of pregnancy. Twenty eight out of 34 cases were admitted into the hospital as emergency. As for the treatment, 9 cases received emergency neurosurgery, 3 cases received caesarean section and neurosurgery, 12 cases received emergency neurosurgery after caesarean section, 7 cases received conservative treatment, and 3 cases withdrew treatment after caesarean section. In neurosurgery treatment, 19 cases received brain mass lesion resection, 3 cases received hematoma clearance or decompression, 2 cases respectively received ventricular-peritoneal shunt and endovascular treatment. For obstetric management, 27 cases terminated pregnancy and 7 cases were expected to delivery. Twenty six out of 27 cases in the middle and late trimester of pregancy underwent caesarean section, and among them, 16 and 10 cases respectively received epidural and general anesthesia. The Observer′s Assessment of Alertness/Sedation(OAA/S) in patients received general anesthesia was lower than those received epidural anesthesia (P<0.05). MAP decreased more rapidly after delivery in patients under epidural anesthesia during surgery. There were 4 cases of maternal death and 2 cases of fetal death. Conclusions Intracranial mass lesion during pregnancy increased the risk of maternal and fetal death. The appropriate treatment requires comprehensive diagnosis involving obstetrician, anesthesiologists and neurosurgeons to fully evaluate patient′s intracranial tumor, gestational age and fetal maturity to timely terminate pregnancy and carry out appropriate neurosurgical treatment to ensure the safety of mother and fetus. Key words: Pregnancy; Intracranial mass lesion; Anesthesia; Neurosurgery