title: Management strategies for acute brain lesions presenting during pregnancy: a case series.
abstract: BACKGROUND
  The management of brain lesions diagnosed during pregnancy is challenging to both obstetricians and neurosurgeons. In this study, a series of nine pregnant women were admitted to neurosurgery presenting with different acute brain lesions.
  
  
  OBJECTIVE
  To establish guidelines for the management of acute brain lesions that present during pregnancy.
  
  
  METHODS
  Retrospective review of the medical records of all pregnant women admitted for urgent care to King Khalid University Hospital (KKUH) from 1995 to 2009.
  
  
  RESULTS
  Eight patients were multiparous, and one was primigravida, two were in the first trimester, and seven were in the second or third trimester. The mean age was 30.5 years. Six patients had brain tumours, while one patient had tuberculoma, and two had aneurismal subarachnoid haemorrhages (SAH). Three patients completed a full term pregnancy following surgery. Two patients had emergency caesarean section (CS) immediately followed by neurosurgery in the same session. Two patients completed their pregnancies to full term and had craniotomies after delivery. Two patients had therapeutic abortions followed by neurosurgery. No maternal or foetal complications were recorded in this series.
  
  
  CONCLUSIONS
  The management of pregnant patients with acute brain lesions should be individualised and multidisciplinary. As it is difficult to allocate a single, general treatment protocol to pregnant patients with brain lesions, we suggest the following guidelines: for patients in the second and early third trimesters, it is safe to perform a craniotomy first and allow the patient to complete a full term pregnancy. For patients at 34 weeks or more of gestation, emergency CS followed by a craniotomy is recommended. For patients in the 1st trimester, it is advisable to terminate the pregnancy to allow safe management, although the laws governing this will vary from country to country. For patients with benign tumours who respond to corticosteriods, it is possible to complete the pregnancy and postpone surgery until after delivery.
authors.affiliation: Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia. smfwat@yahoo.com
authors.forename: Sherif
authors.initials: S
authors.lastname: Elwatidy
authors.forename: Zain
authors.initials: Z
authors.lastname: Jamjoom
authors.forename: Essam
authors.initials: E
authors.lastname: Elgamal
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdelwahab
mesh_terms: D000208:Acute Disease; D000328:Adult; D001927:Brain Diseases / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography; D005260:Female; D020773:Headache Disorders / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery*; D011256:Pregnancy Outcome; D011295:Prenatal Care; D011296:Prenatal Diagnosis; D012640:Seizures / Q000209:etiology