Management of vestibular schwannoma during pregnancy: A systematic review

This systematic review evaluates the management strategies for vestibular schwannoma (acoustic neuroma) during pregnancy, a rare but significant clinical condition, by synthesizing findings from case reports.

A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases. Relevant case reports were included based on predefined inclusion and exclusion criteria. Data were extracted on patient demographics, tumor characteristics, clinical symptoms, management strategies, and outcomes.

Thirty-seven cases were included, with a mean patient age of 28.72 years and a mean gestational age at diagnosis of 26.63 weeks. Hearing loss was the most common symptom (92.3%), followed by facial numbness (53.8%) and headache (41%). Tumor sizes ranged from 2.0 to 6.5 cm, with larger tumors associated with increased neurological symptoms. Surgical intervention was performed post-delivery in 78.9% of cases, while 21.1% underwent surgery during pregnancy. Seizures showed a statistically significant difference with the timing of surgery, with one case occurring during pregnancy and none post-delivery (p = 0.05). Most cases were managed conservatively, with surgery deferred until postpartum unless neurological decline or tumor growth warranted earlier intervention.

The management of vestibular schwannoma during pregnancy requires a multidisciplinary approach, balancing maternal and fetal health. Conservative management is generally preferred, with surgical intervention reserved for cases with significant symptoms. Hormonal changes during pregnancy may exacerbate tumor growth, underscoring the need for early diagnosis and careful monitoring. Further research is needed to optimize management guidelines and improve outcomes.