title: A case series discussing the anaesthetic management of pregnant patients with brain tumours.
abstract: Pregnancy may aggravate the natural history of an intracranial tumour, and may even unmask a previously unknown diagnosis. Here we present a series of seven patients who had brain tumours during pregnancy. The aim of this case series is to characterize the current perioperative management and to suggest evidence based guidelines for the anaesthetic management of pregnant females with brain tumours. This is a retrospective study. Information on pregnant patients diagnosed with brain tumours that underwent caesarean section (CS) and/or brain tumour resection from May 2003 through June 2008 was obtained from the Department of General Anaesthesia and the Rose Ella Burkhardt Brain Tumour & Neuro-Oncology Centre (BBTC) at the Cleveland Clinic, OH, USA. The mean age was 34.5 years (range 29-40 years old). Six patients had glioma, two of whom had concomitant craniotomy and CS. Six cases had the tumour in the frontal lobe. Four cases were operated on under general anaesthesia and three underwent awake craniotomy. The neonatal outcomes of the six patients with elective or emergent delivery were six viable infants with normal Apgar scores. Pregnancy was terminated in the 7th patient. In conclusion, good knowledge of the variable anesthetic agents and their effects on the fetus is very important in managing those patients.
authors.affiliation: Department of Anesthesiology, University of Cincinnati, Cincinnati, OH, 45267, USA ; Department of Outcomes Research, Anesthesia Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
authors.forename: Alaa A
authors.initials: AA
authors.lastname: Abd-Elsayed
authors.affiliation: Department of General Anesthesia, Cleveland Clinic, Cleveland, OH, 44195, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Díaz-Gómez
authors.affiliation: Neurological Surgery and Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, 44195, USA.
authors.forename: Gene H
authors.initials: GH
authors.lastname: Barnett
authors.affiliation: Department of Outcomes Research, Anesthesia Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kurz
authors.affiliation: Department of General Anesthesia, Cleveland Clinic, Cleveland, OH, 44195, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Inton-Santos
authors.affiliation: Obstetrics & Gynecology Anesthesia, Hillcrest Hospital, Cleveland, OH, 44195, USA.
authors.forename: Sabri
authors.initials: S
authors.lastname: Barsoum
authors.affiliation: Department of General Anesthesia, Cleveland Clinic, Cleveland, OH, 44195, USA.
authors.forename: Rafi
authors.initials: R
authors.lastname: Avitsian
authors.affiliation: Department of General Anesthesia, Cleveland Clinic, Cleveland, OH, 44195, USA.
authors.forename: Zeyd
authors.initials: Z
authors.lastname: Ebrahim
authors.affiliation: Anesthesiology, University of Virginia Health System, Charlottesville, VA, 22093, USA.
authors.forename: Vesna
authors.initials: V
authors.lastname: Jevtovic-Todorovic
authors.affiliation: Department of Outcomes Research, Anesthesia Institute, Cleveland Clinic, Cleveland, OH, 44195, USA ; Department of General Anesthesia, Cleveland Clinic, Cleveland, OH, 44195, USA.
authors.forename: Ehab
authors.initials: E
authors.lastname: Farag