Commentary

In this retrospective study, the authors reported the results of 18 pregnant women with a meningioma from a series of 600 cases. Seven of the 18 women underwent surgery during pregnancy due to their progressive visual impairment. Only 46.86% of them had noticeable improvement. Of 9 undergoing surgery after pregnancy, five had visual impairment, and it was permanent in three cases preoperatively. Of these cases only one had visual improvement postoperatively.

It is very well known that pregnancy may precipitate growth of meningiomas and that meningiomas are more frequent in women. In their retrospective study, instead of taking the pregnant women as the main selection group, the authors have chosen their 18 cases from a series of 600 cases (men and women) with meningiomas. A conclusion regarding the incidence cannot be made from this study.

The data are also insufficient to suggest that meningiomas during pregnancy are frequently seen around the sellar region. However, progressive or severe visual impairment was the main indication for surgery in these pregnant patients and should be the surgical indication for most tumor cases. The authors recommend the use of corticosteroids for treating severe edema in pregnant women with a meningioma. This recommendation is open to discussion. Their conclusion is to continue to a full-term delivery without surgery if there is no neurological impairment. This strategy has been accepted by all surgeons.

Contrary to the conclusions of these authors, we conclude that visual outcome was improved or stable in most operated patients, and did not improve in patients with advanced visual decline. This is a good reason to operate early in patients with progressive visual deficit rather than waiting till full-term to see if the tumor will regrow, or to avoid deleterious effects on the fetus.

This is a large series of pregnant patients with meningiomas, and we commend the authors of the study.