Awake brain tumor resection during pregnancy: Decision making and technical nuances

Lingzhong Meng, Seunggu (Jude) Han, Mark D. Rollins, Adrian W. Gelb, Edward F. Chang

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

The co-occurrence of primary brain tumor and pregnancy poses unique challenges to the treating physician. If a rapidly growing lesion causes life-threatening mass effect, craniotomy for tumor debulking becomes urgent. The choice between awake craniotomy versus general anesthesia becomes complicated if the tumor is encroaching on eloquent brain because considerations pertinent to both patient safety and oncological outcome, in addition to fetal wellbeing, are involved. A 31-year-old female at 30 weeks gestation with twins presented to our hospital seeking awake craniotomy to resect a 7 × 6 × 5 cm left frontoparietal brain tumor with 7 mm left-to-right subfalcine herniation on imaging that led to word finding difficulty, dysfluency, right upper extremity paralysis, and right lower extremity weakness. She had twice undergone tumor debulking under general anesthesia during the same pregnancy at an outside hospital at 16 weeks and 28 weeks gestation. There were considerations both for and against awake brain tumor resection over surgery under general anesthesia. The decision-making process and the technical nuances related to awake brain tumor resection in this neurologically impaired patient are discussed. Awake craniotomy benefits the patient who harbors a tumor that encroaches on the eloquent brain by allowing a greater extent of resection while preserving the language and sensorimotor function. It can be successfully done in pregnant patients who are neurologically impaired. The patient should be motivated and well informed of the details of the process. A multidisciplinary and collaborative effort is also crucial.

Original languageEnglish (US)
Pages (from-to)160-162
Number of pages3
JournalJournal of Clinical Neuroscience
Volume24
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

Fingerprint

Craniotomy
Brain Neoplasms
Decision Making
General Anesthesia
Pregnancy
Neoplasms
Paraplegia
Brain
Patient Safety
Upper Extremity
Language
Physicians

Keywords

  • Awake craniotomy
  • Decision making
  • Malignant brain tumor
  • Pregnancy
  • Technical nuances

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Awake brain tumor resection during pregnancy : Decision making and technical nuances. / Meng, Lingzhong; Han, Seunggu (Jude); Rollins, Mark D.; Gelb, Adrian W.; Chang, Edward F.

In: Journal of Clinical Neuroscience, Vol. 24, 01.02.2016, p. 160-162.

Research output: Contribution to journalArticle

Meng, Lingzhong ; Han, Seunggu (Jude) ; Rollins, Mark D. ; Gelb, Adrian W. ; Chang, Edward F. / Awake brain tumor resection during pregnancy : Decision making and technical nuances. In: Journal of Clinical Neuroscience. 2016 ; Vol. 24. pp. 160-162.
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