Anesthetic management of 29 week pregnant patient undergoing craniotomy for pituitary macroadenoma. A case report

Intracranial space-occupying lesions are rarely present during pregnancy and these disorders seldom require immediate surgical attention. The most common among them is pituitary tumor of which 15-35% has a chance of enlarging during pregnancy. The decision to proceed with surgical intervention depends on the site, size, and type of the tumor, gestational age and neurological signs as well as the patient's wishes. In case of surgery, multidisciplinary approach is essential in perioperative period. Maternal alterations during pregnancy may complicate the anesthetic management of patients and increase monitoring requirements for safety of both mother and fetus. Unfortunately, this may become a challenge to all attending physicians, but especially to the anesthesiologists, as the anesthetic plan must meet the needs of both pregnancy and neurosurgery. Here, we present 29-week pregnant patient undergoing craniotomy for pituitary adenoma and discuss the features of anesthesia providing maternal and fetal safety

Therapeutic Difficulty in a Case of Supratentorial Primitive Neuroectodermal Tumor Diagnosed during Pregnancy

We report a supratentorial primitive neuroectodermal tumor (sPNET) in 17-year-old primipara in the second trimester her pregnancy. Magnetic resonance imaging revealed a left frontoparietal mass with solid and cystic component. Gross-total resection was achieved via a left frontoparietal craniotomy. It was decided to suspend the radiotherapy and chemotherapy until the 30 weeks of gestation. But, a sudden uncal herniation was developed due to the reccurrence of the tumor and bleeding into the tumor at the 25 weeks of gestation and the patient died after urgent decompressive surgery. sPNETs is an extremely rare brain tumor in pregnancy and only two cases were reported in the literature to date. There is no universally agreed treatment protocol for sPNETs during pregnancy and a multidisciplinary approach is required in treatment. In the present study, the clinical, histopathological features and therapeutical difficulties of sPNETs diagnosed during pregnancy was discussed with the literature review.