2025 Poster Presentations
P118: POSTERIOR FOSSA CRANIOTOMY IN PREGNANT PATIENTS: A CASE REPORT AND REVIEW OF THE LITERATURE
Alexa R Lauinger1; Sam Schulz2; Logan Burrington1; Ankitha Iyer3; Prapthi Sirrkay2; Anant Naik, MD4; Andrew S Venteicher, MD, PhD5; 1Carle Illinois College of Medicine; 2University of Minnesota; 3Wake Forest University School of Medicine; 4Department of Neurosurgery, University of Minnesota; 5Department of Neurosurgery, Center for Skull Base and Pituitary Surgery, University of Minnesota
Introduction: Posterior fossa neurosurgeries are complicated by the difficult anatomy and delicate structures surrounding that area. The need for extensive preoperative planning is increased during pregnancy due to risk of complications. Early discussion is necessary with consideration of gestational age and severity of the lesion to determine the need for earlier interventions. This paper aims to discuss the current understanding of posterior fossa procedures during pregnancy and present a case to demonstrate clinical reasoning.
Case Report: This case describes a 35-year-old female with history of von Hippel-Lindau syndrome and previously known cerebellar hemangiomas. It was originally decided to delay stereotactic radiosurgery due to pregnancy; however, the patient began presenting with headaches, nausea, and vomiting. At 35 weeks gestational age, she underwent a C-section followed by a craniotomy. Postoperatively the patient showed improved dysmetria and was doing well at a four-month follow-up.
Methods: A comprehensive review of the literature, using PubMed, was completed for articles discussing the treatment of pregnant patients with a posterior fossa lesion. Case reports, letters to the editor, and retrospective studies were included.
Results: Nine reports of posterior fossa lesions during pregnancy were found in the literature. Including the reported case, eight of the patients underwent a neurosurgical procedure, most commonly following a C-section. However, one patient with surgery completed at the gestational age of 12 weeks had a normal vaginal delivery at term. The most common lesion was hemangioma, and only three of the patients had a reported follow-up discussed.
Discussion: Pregnancy is a complicating factor of neurosurgical procedures. This is especially true in complex cases, such as posterior fossa lesions. Current care for these patients depends upon gestational age, intracranial pressure, and response to nonsurgical management. Procedures may be complicated by difficulty in positioning and risk for teratogenicity. These patients required increased monitoring and close follow-up postoperatively.
Conclusion: Due to the increased complexity of procedures in pregnant patients, increased communication between the entire healthcare team and patient is required to improve patient outcome. This includes coordination between neurosurgeons, neurologists, obstetrics, and neuroanesthesiologists.