Published in:
01-12-2019 | Meningioma | Endocrine Surgery
Multidisciplinary team efforts improve the surgical outcomes of sellar region lesions during pregnancy
Published in: Endocrine | Issue 3/2019
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Purpose
Treatment of space-occupying lesions (SOLs) in the sellar region is a clinical challenge, especially in pregnant women because many treatment decisions are restrained due to pregnancy. We attempt to discuss the surgical indications and timing for pregnant patients and highlight the importance of multidisciplinary team (MDT) treatment.
Methods
From August 2017 to February 2018, four pregnant women were admitted to our hospital with severe visual impairment due to sellar region SOLs, including two cases of tuberculum sellae meningioma, one case of giant pituitary adenoma and one case of a pituitary abscess. All four patients were safely treated by surgery during the second and third trimesters of pregnancy through concerted efforts of the MDT, including a neurosurgeon as the team leader in combination with experts in obstetrics, ophthalmology and endocrinology.
Results
The SOLs were removed completely from all four patients, resulting in significantly improved vision without operation-related complications. Pregnancy continued postoperatively to full-term delivery in three of the four patients. The other patient with a pituitary abscess selected to terminate the pregnancy at a gestational age of 20 weeks because of her own concerns. The four babies (including a pair of twins) were born healthy and had developed normally at the 6-week postpartum follow-up.
Conclusions
With the MDT guiding the decision-making process, surgical resection of sellar region SOLs in pregnant women with severe visual impairment is practical to improve the prognosis without affecting the outcomes of pregnancy for either the mother or the infant.