title: Neurosurgery and pregnancy.
abstract: BACKGROUND
  Pregnant women with pathological conditions requiring a neurosurgical intervention pose a unique therapeutic challenge. Changes in normal physiology add to the complexity of patient management. We describe our experience in treating various neurosurgical diseases in parturient women.
  
  
  METHODS
  Thirty-four pregnant and early postpartum women were treated at our center between 2003 and 2010. The general guideline used in these patients (now deserving re-evaluation based on the presented data) was to postpone surgery until the patient reached term (weeks 34-38 of gestation) unless there was evidence of a life- or function-threatening condition, in which case surgery was promptly performed.
  
  
  RESULTS
  Sixteen patients underwent neurosurgical intervention during pregnancy between 11 to 34 weeks of gestation (7 tumor, 3 vascular, 2 VP shunt, 2 spinal, 2 trauma). Thirteen women underwent a neurosurgical procedure after delivery (12 tumor, 1 spine), and 5 women were treated conservatively (2 vascular lesions, 3 trauma). Three patients underwent abortions (one spontaneous and two elective). The other 31 women delivered at 30-42 weeks' gestation. Of 12 patients whose definitive neurosurgical procedure was initially delayed, 5 were not able to complete their pregnancy naturally. Of 21 patients that underwent a cesarean section (CS), 3 were performed urgently. Although two pairs of twins and two singletons had an initial low Apgar score (<7), the outcome for all the neonates was good. Neurosurgical outcome was satisfactory.
  
  
  CONCLUSIONS
  Our experience demonstrates the safety of neurosurgical intervention and anesthesia during pregnancy. Delaying intervention often resulted in maternal deterioration and urgent intervention. Thus, pregnancy by itself should not be considered a major contraindication for performing a neurosurgical procedure, which should be considered early rather than late in most patients.
authors.affiliation: Department of Neurosurgery, Tel Aviv Medical Center, Israel.
authors.forename: Erez
authors.initials: E
authors.lastname: Nossek
authors.forename: Margaret
authors.initials: M
authors.lastname: Ekstein
authors.forename: Eli
authors.initials: E
authors.lastname: Rimon
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kupferminc
authors.forename: Zvi
authors.initials: Z
authors.lastname: Ram
mesh_terms: D000328:Adult; D015331:Cohort Studies; D000075202:Contraindications; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008137:Longitudinal Studies; D009422:Nervous System Diseases / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000592:standards*; D018579:Patient Selection; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D055815:Young Adult