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Craniotomy for suprasellar meningioma in a 28-week pregnant woman without fetal heart rate monitoring

[La craniotomie pour un méningiome suprasellaire chez une femme enceinte de 28 semaines, sans monitorage de la fréquence cardiaque ftale]

From the Department of Anesthesia, The Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Pirjo H. Manninen, Department of Anesthesia, The Toronto Western Hospital, 2 EC-046, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Phone: 416-603-5118; Fax: 416-603-6494; E-mail: Pirjo.Manninen{at}uhn.on.ca

Purpose: To illustrate the anesthetic management of a craniotomy for suprasellar meningioma in a 28-week pregnant woman and to review the considerations for fetal monitoring during surgery.

Clinical features: A 33-yr-old woman presented at 28 weeks of gestation with rapidly deteriorating vision in her right eye. Neuroradiological investigations revealed a large suprasellar meningioma extending into the frontal lobe. She underwent a craniotomy for excision of the tumour at 28 weeks gestation because of the risk of irreversible blindness. Anesthetic management was tailored for pregnancy and an intracranial tumour. Intraoperative blood pressure was maintained within 10% of baseline and respiratory variables were stable. No fetal heart rate monitoring was used during the surgery, as there was no plan to perform an emergency Cesarean delivery even in the event of change in fetal monitoring. The aim was to treat the mother aggressively for any untoward events. She made a good neurological recovery after the procedure and had a spontaneous vaginal delivery at 40 weeks of gestation without any neonatal complications.

Conclusions: Anesthetic management of a brain tumour during pregnancy should be tailored to the individual patient according to the circumstances. It is possible to perform this type of procedure without fetal heart rate monitoring. The decision regarding fetal monitoring should be based on the consensus of the multidisciplinary care team and the mother.

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