A case of endoscopic endonasal surgery for a tuberculum sellae meningioma resected in the third trimester of pregnancy

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Background Meningiomas are known to be able to grow rapidly during pregnancy. Moreover, tuberculum sellae meningiomas present with progressive visual dysfunction and occasionally require immediate surgical intervention. Here, we report on the intraoperative and perioperative management of a patient with a tuberculum sellae meningioma who underwent endoscopic endonasal surgery (EES) in the third trimester of pregnancy. Case Description A 43-year-old woman, gravida 1, para 1, presented with rapidly progressive visual impairment of the left eye. Head magnetic resonance imaging revealed a tuberculum sellae meningioma and surgical intervention was planned for after delivery. However, the patient’s visual impairment progressed further during the pregnancy. Collaboration between the obstetricians and neurosurgeons was established, and the tumor was resected through EES in the third trimester of pregnancy. In surgeries performed in the third trimester of pregnancy, preterm delivery is a well-known complication. Therefore, perioperative uterine contraction monitoring and transvaginal ultrasonography were performed. Considering that the risk of postoperative cerebrospinal fluid leak is high in pregnant women, lumbar drainage was used while at the same time considering that the risk of deep venous thrombosis (DVT) was also increased. Perioperative lower limb ultrasonography was performed frequently, and anticoagulation therapy was initiated postoperatively. The patient was discharged on the 12th postoperative day and underwent a full-term delivery at 37 weeks of pregnancy. Conclusion EES for pregnant women in the third trimester must be done in close collaboration between obstetricians and neurosurgeons to detect preterm delivery and prevent DVT. This collaboration will lead to safe and effective treatment.

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