Vestibular Schwannomas in Pregnancy: A Case Series

Abstract

Objectives

Vestibular schwannomas (VS) are benign intracranial tumors, the majority of which are indolent and managed conservatively with active surveillance. VS during pregnancy is rare and poorly understood. It is unclear whether hormonal changes during pregnancy contribute to VS growth. Currently, the largest case series describing VS during pregnancy comprises six cases from the Mayo Clinic in 1993, where they note that tumors tend to be larger and associated with higher surgical morbidity. We present five further cases of peripartum VS and their management strategies.

Design

A retrospective review of 540 consecutive patients with sporadic VS at St George's Hospital from 2017 to 2023 was performed.

Setting

St George's Hospital is a tertiary hospital in London providing joint neurosurgical and ENT management of VS.

Participants

A total of 280 out of 540 patients were female (52%), and 5 were either pregnant at presentation or had given birth within 6 months of presentation (1%).

Main Outcome Measures

Maternal/infant well-being, postoperative complications, and facial nerve function were our main outcome measures.

Results

All patients had tumors >30 mm requiring translabyrinthine resection. One underwent VS resection with intraoperative lactation breaks 1 week following elective cesarean section. Two required cerebrospinal fluid (CSF) shunts to delay resection. One had her resection while 21 weeks pregnant. All had intact postoperative facial nerve function and healthy babies. One experienced a CSF leak requiring a lumbar drain.

Conclusion

Because pregnancy tends to be associated with large tumors and surgery is complicated by obstetric considerations, appropriate counselling should be given to women of childbearing age.

Keywords

vestibular schwannoma - pregnancy - skull base - neurosurgery - otolaryngology - temporal bone - tumor - cerebellopontine angle

Publikationsverlauf

Eingereicht: 30. November 2024

Angenommen: 14. März 2025

Artikel online veröffentlicht:
08. April 2025

• References

• 1 Lanser MJ, Sussman SA, Frazer K. Epidemiology, pathogenesis, and genetics of acoustic tumors. Otolaryngol Clin North Am 1992; 25 (03) 499-520
• 2 Gaughan RK, Harner SG. Acoustic neuroma and pregnancy. Am J Otol 1993; 14 (01) 88-91
• 3 Bao M, He Y, Tao Y. et al. Large vestibular schwannomas presenting in the late state of pregnancy: a case report and literature review. Front Neurol 2023; 14: 1270989
• 4 Schoemaker MJ, Swerdlow AJ, Auvinen A. et al. Medical history, cigarette smoking and risk of acoustic neuroma: an international case-control study. Int J Cancer 2007; 120 (01) 103-110
• 5 Brown CM, Ahmad ZK, Ryan AF, Doherty JK. Estrogen receptor expression in sporadic vestibular schwannomas. Otol Neurotol 2011; 32 (01) 158-162
• 6 Kasantikul V, Brown WJ. Estrogen receptors in acoustic neurilemmomas. Surg Neurol 1981; 15 (02) 105-109
• 7 Klinken L, Thomsen J, Rasmussen BB, Wiet RJ, Tos M. Estrogen and progesterone receptors in acoustic neuromas. Arch Otolaryngol Head Neck Surg 1990; 116 (02) 202-204
• 8 Cazzador D, Astolfi L, Daloiso A. et al. Tumor microenvironment in sporadic vestibular schwannoma: a systematic, narrative review. Int J Mol Sci 2023; 24 (07) 6522
• 9 Torry DS, Hinrichs M, Torry RJ. Determinants of placental vascularity. Am J Reprod Immunol 2004; 51 (04) 257-268
• 10 Goutagny S, Kalamarides M. Medical treatment in neurofibromatosis type 2. Review of the literature and presentation of clinical reports. Neurochirurgie 2018; 64 (05) 370-374
• 11 Black FO. Maternal susceptibility to nausea and vomiting of pregnancy: is the vestibular system involved?. Am J Obstet Gynecol 2002; 186 (5, Suppl Understanding) S204-S209
• 12 Lee NM, Saha S. Nausea and vomiting of pregnancy. Gastroenterol Clin North Am 2011; 40 (02) 309-334 , vii
• 13 Fernández-Méndez R, Wan Y, Axon P, Joannides A. Incidence and presentation of vestibular schwannoma: a 3-year cohort registry study. Acta Neurochir (Wien) 2023; 165 (10) 2903-2911
• 14 Office for National Statistics. Birth characteristics in England and Wales: 2022. Accessed October 27, 2024 at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthcharacteristicsinenglandandwales/2022
• 15 Shah KJ, Chamoun RB. Large vestibular schwannomas presenting during pregnancy: management strategies. J Neurol Surg B Skull Base 2014; 75 (03) 214-220
• 16 Warland J. Back to basics: avoiding the supine position in pregnancy. J Physiol 2017; 595 (04) 1017-1018
• 17 Winterstein AG, Thai TN, Nduaguba S. et al. Risk of fetal or neonatal death or neonatal intensive care unit admission associated with gadolinium magnetic resonance imaging exposure during pregnancy. Am J Obstet Gynecol 2023; 228 (04) 465.e1-465.e11
• 18 Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 2016; 316 (09) 952-961
• 19 Alghamdi Sr SAS. Gadolinium-based contrast agents in pregnant women: a literature review of MRI safety. Cureus 2023; 15 (05) e38493
• 20 Royal College of Radiologists. Guidance on gadolinium-based contrast agent administration to adult patients. 2019: 9
• 21 Webb JAW, Thomsen HS, Morcos SK. Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 2005; 15 (06) 1234-1240
• 22 Bajwa SJS, Bajwa SK. Anaesthetic challenges and management during pregnancy: strategies revisited. Anesth Essays Res 2013; 7 (02) 160-167