Neurosurgical considerations on highly eloquent brainstem cavernomas during pregnancy

Area of Science:

• Neurology
• Neurosurgery
• Obstetrics

Background:

• Cerebral cavernous malformations (CCMs), particularly in eloquent brain regions like the brainstem, pose unique challenges during pregnancy.
• Limited literature exists on the optimal management strategies for these rare occurrences.

Observation:

• This study analyzed three pregnant patients with symptomatic brainstem CMs managed by the senior author.
• A literature review identified 12 additional cases of brainstem cavernomas during pregnancy.

Findings:

• Only one patient in the series underwent surgery during pregnancy; the other two were treated post-delivery.
• Literature review indicated only two of 12 pregnant patients with brainstem cavernomas were operated on during gestation.

Implications:

• Surgical treatment for brainstem CMs in pregnancy is infrequently necessary, but critical in emergent, rapidly progressing scenarios.
• Pregnant patients with eloquent brainstem CMs require specialized multidisciplinary care to determine the optimal timing for intervention.