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Successful brainstem cavernous malformation resection after repeated hemorrhages during pregnancy
Kelly D Flemming1, Brent P Goodman, Fredric B Meyer
1Departments of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Surgical Neurology
|December 13, 2003
Summary
Pregnancy can increase the risk of bleeding in cavernous malformations. Surgical removal during pregnancy is possible and can lead to successful outcomes for both mother and child.
Area of Science:
- Neurology
- Neurosurgery
- Obstetrics
Background:
- Pregnancy is increasingly recognized as a potential risk factor for aggressive behavior in patients with cavernous malformations.
- Limited literature exists on the management of cavernous malformations during pregnancy, highlighting a significant knowledge gap.
Observation:
- A 28-year-old pregnant patient at 27 weeks gestation experienced two hemorrhages from a pontine cavernous malformation within one week.
- The second hemorrhage led to increased patient morbidity, underscoring the acute risks associated with these lesions during gestation.
Findings:
- Surgical excision of the pontine cavernous malformation was successfully performed via suboccipital craniotomy during pregnancy.
- The patient achieved a successful delivery of a healthy infant at 36 weeks gestation.
- Postoperatively, the patient regained ambulation and independence, demonstrating a positive long-term outcome.
Implications:
- This case suggests that pregnancy and a history of hemorrhage are significant risk factors for recurrent bleeding from cavernous malformations.
- Complex management decisions for cavernous malformations during pregnancy are highlighted, yet successful surgical intervention is feasible.
- The findings support considering surgical management in select pregnant patients with symptomatic cavernous malformations to mitigate risks and ensure favorable maternal and fetal outcomes.