Commentary

We thank the authors for sharing their experience and addressing this ethical, emotional, and social concern. The report on 18 patients with meningiomas during pregnancy is invaluable information because surgeons in the West seldom encounter these conditions. Their series incorporates a prior report of a rapid growth during pregnancy associated with progressive deficit, rightly emphasizing that if no surgical intervention was indicated, close monitoring until full-term delivery is recommended. I wish the authors had addressed the age of pregnancy because at each trimester, the viability and risks to the fetus are different. Having dealt with several similar cases in the past, our practice was to avoid intervention unless the mother's life or function was threatened during the first trimester to avoid any risks of fetal defect. It appears that in the second trimester, one could safely operate based on the most contemporary knowledge, if as the authors indicated, intracranial pressure had increased or a neurological deficit had progressed. During the third trimester with a viable fetus, one could proceed with delivery depending on signs of progression, increased intracranial pressure, or fetal need. We have avoided vaginal delivery and labor when any sign of increased intracranial pressure or a mass lesion was present. In such cases we choose a caesarean section to avoid prolonged labor.