Visual loss caused by rapidly progressive intracranial meningiomas during pregnancy

Three cases of intracranial meningiomas occurring in young pregnant women are presented. The typical growth pattern of these tumors is slow, producing insidious and chronic visual disturbances. In contrast, during pregnancy meningiomas may follow a rapidly progressive course, producing dramatic and relatively acute visual loss. This accelerated growth pattern is probably mediated by hormone receptors in these tumors. Nausea, vomiting, and other symptoms caused by the tumor may be attributed to pregnancy, delaying the diagnosis. Symptoms may abate spontaneously after delivery only to recur with greater rapidity and severity during subsequent pregnancies. Hormone-responsive intracranial meningiomas must be considered in the differential diagnosis of visual disturbances during pregnancy. Close cooperation between the ophthalmologist, neurosurgeon, obstetrician, and neonatologist is essential for an optimal outcome. Although surgical excision remains the treatment of choice, hormonal therapy may be valuable in treating unresectable or partially resectable meningiomas.