scholarly journals Management Strategies for Brain Tumors Diagnosed during in Pregnancy: A Case Report and Literature Review

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 613
Author(s):  
Reona Shiro ◽  
Kosuke Murakami ◽  
Masaharu Miyauchi ◽  
Yasuhiro Sanada ◽  
Noriomi Matsumura
Keyword(s):  
Brain Tumor ◽  
Intracranial Pressure ◽  
Brain Tumors ◽  
Case Reports ◽  
Termination Of Pregnancy ◽  
Comprehensive Treatment ◽  
Increased Intracranial Pressure ◽  
Maternal Brain ◽  
Group A ◽  
Group B

Background and Objectives: Maternal brain tumors diagnosed during pregnancy are very rare, and their clinical course remains incompletely understood. We recently experienced a case of a brain tumor diagnosed at 30 weeks of gestation, and the treatment was initiated after delivery at 32 weeks of gestation. In this study, we reviewed case reports of brain tumors diagnosed during pregnancy, focusing on whether the brain tumor was treated during pregnancy or after termination of pregnancy and on the timing of therapeutic intervention. Materials and Methods: We searched PubMed and Ichushi-Web for articles published after January 2000 that reported cases of maternal brain tumors diagnosed during pregnancy. The patients were divided into two groups according to whether the tumor was treated during pregnancy (Group A) or after termination of pregnancy (Group B). Results: In total, 42 patients were included in the study (13 (31%) in Group A and 29 (69%) in Group B). The most common symptoms before diagnosis were those caused by increased intracranial pressure (57.1%). The diagnosis was made at 18 ± 6 weeks of gestation in Group A and 26 ± 9 weeks of gestation in Group B (p = 0.007). In all cases diagnosed after 34 weeks of gestation, termination of pregnancy was followed by treatment. Treatment was initiated within two weeks of diagnosis in 50% of patients in Group A and 30% in Group B. Conclusions: When severe symptoms caused by increased intracranial pressure last for several weeks, imaging tests should be considered. Termination of pregnancy is a good option for a brain tumor diagnosed after 34 weeks of gestation, while comprehensive treatment decisions should be made based on the severity of symptoms and the course of pregnancy in other cases.

Venous sinus stenting shortens the duration of medical therapy for increased intracranial pressure secondary to venous sinus stenosis

2017 ◽  
Vol 10 (3) ◽  
pp. 310-314 ◽  
Author(s):  
Tarek A Shazly ◽  
Ashutosh P Jadhav ◽  
Amin Aghaebrahim ◽  
Andrew F Ducruet ◽  
Brian T Jankowitz ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Medical Therapy ◽  
Venous Sinus ◽  
Increased Intracranial Pressure ◽  
Rnfl Thickness ◽  
Group A ◽  
Sinus Stenosis ◽  
The Mean ◽  
Group B

IntroductionMedical treatment, cerebrospinal fluid (CSF) shunting, and optic nerve sheath fenestration are standard treatments for increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH). Venous sinus stenting provides a novel alternative surgical treatment in cases of venous sinus stenosis with elevated ICP.Methods12 consecutive subjects with papilledema, increased ICP, and radiological signs of dural sinus stenosis underwent cerebral venography and manometry. All subjects had papilledema and demonstrated radiological evidence of dural venous sinus stenosis.ResultsSix subjects chose venous stenting (Group A) and six declined and were managed conservatively with oral acetazolamide (Group B). The relative pressure gradient across the venous narrowing was 29±16.3 mm Hg in Group A and 17.6±9.3 mm Hg in Group B (p=0.09). The mean lumbar puncture opening pressure was 40.4±7.6 cm H2O in Group A and 35.6±10.6 cm H2O in Group B (p=0.4). Spectral domain optical coherence tomography (SD-OCT) showed mean average retinal nerve fiber layer (RNFL) thickness of 210±44.8 µm in Group A and 235±124.7 µm in Group B. However, the mean average RNFL thickness at 6 months was 85±9 µm in Group A and 95±24 µm in Group B (p=0.6). The total duration of acetazolamide treatment was 188±209 days in Group A compared with 571±544 days in Group B (p=0.07).ConclusionsIn subjects with venous sinuses stenosis, endovascular stenting offers an effective treatment option for intracranial hypertension which may shorten the duration of medical therapy.

scholarly journals Evaluate the Feasibility of Gd-based Contrast Clearance Differenceto Delineate Subvolume Target in Primary and Metastatic Brain Tumors Radiotherapy- A Prospective Study

2020 ◽  
Author(s):  
Yin Xing Wang ◽  
Guan Zhong Gong ◽  
Ya SU ◽  
Li Zhen WANG ◽  
Jie LU ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Contrast Agent ◽  
Mean Value ◽  
Metastatic Brain Tumors ◽  
Contrast Extravasation ◽  
Fusion Images ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background: To evaluate the feasibility ofdelineating subvolume target in brain tumor radiotherapy using gd-based contrast clearance difference.Methods：Twenty-six patients with malignant brain tumor were scanned with MRI. The first and second acquisitions of standard T2-weighted images (T2WI) andT1-weighted images (T1WI) were respectively performed?> at 5 minutes and 60 minutesafter injection of contrast agent. Delayed contrast extravasation MRI(DCEM) computed by Brainlab concludesregions of contrast agent clearance which represent active tumor，andregions of contrast accumulation which represent non-tumor tissues. Based on T2WI images,14 patients were divided into group A and group B, with andwithout liquefaction necrosis, respectively. Then,gross target volume (GTV) was delineated on T1WI images. Based on the GTV, active tumor (GTV tumor) and non-tumorregions(GTV non-tumor) were delineated on T1WI-DCEM fusion images, whileliquefaction necrosis (GTVliquefaction)and non-liquefaction(GTVnon-liquefaction)were delineated on T1-T2WI fusion images. Finally, the differences between different subvolumes were compared by paired t-test.Results：In group A,the mean value of GTVA was 21.38±25.70 cm3, and the GTVnon-liquefaction and GTVliquefaction were 13.65±18.15cm3 and6.30±7.57cm3, respectively. The GTV tumor was 10.40±13.52 cm3 whilethe GTV non-tumor was 9.55±14.57 cm3, The GTVnon-liquefaction increased by an average of 28.2%（P＜0.05）,compared to GTV tumor . While the GTV non-tumor increased by an average of 46.3% (P＜0.05), compared tothe GTVliquefaction.In group B, the mean value of GTVB on enhanced T1WI was4.39±3.75 cm3. The GTV non-tumorreduced by an average of 50.3% (P＜0.05) , compared totheGTV tumor.Conclusion：Comparedto T2WI, the DCEM has advantages in identifyingthe liquefaction areaand could clearly differentiatesubvolume of active tumor from non-liquefaction necrosis.DCEMis meaningful in guiding the delineation of subvolume in primary and metastatic brain tumors.

Surgical treatment of increased intracranial pressure

1926 ◽  
Vol 22 (3) ◽  
pp. 363
Author(s):  
I. Churaev
Keyword(s):  
Blood Pressure ◽  
Surgical Treatment ◽  
Intracranial Pressure ◽  
Brain Tumors ◽  
Endocrine Glands ◽  
Cerebral Ventricles ◽  
Increased Intracranial Pressure ◽  
Normal Relationship

Disharmony in the growth of the bones of the skull and brain, which is a consequence of a violation of the correlation of the endocrine glands, brain tumors, vascular nodes on the walls of the cerebral ventricles, and finally, a violation of the normal relationship between the blood pressure of the cranial fluid - all this can serve as the cause of increased intracranial pressure.

scholarly journals Evaluation of maternal and perinatal morbidity and mortality in eclampsia by early termination of pregnancy

2020 ◽  
Vol 8 (10) ◽  
pp. 3629
Author(s):  
Suresh C. Mondal ◽  
Sandip Lahiri
Keyword(s):  
Caesarean Section ◽  
Maternal Mortality ◽  
Termination Of Pregnancy ◽  
Early Termination ◽  
Early Presentation ◽  
Neonatal Deaths ◽  
Still Births ◽  
Significant Difference ◽  
Group A ◽  
Group B

 Background: Eclampsia is one of the leading causes of maternal mortality in India.Methods: A prospective observational study was done on 200 pregnant women admitted with antepartum eclampsia in Malda Medical College from 1 April 2017 to 30 October 2019. Group A included patients who delivered through vaginal route within 10 to 12 hrs of eclampsia by stabilisation of patients while Group B included subjects who underwent early caesarean section for uncontrolled convulsions or poor Bishop score. Maternal and perinatal outcomes were compared between the groups. Data was recorded in a pretested performa and was analyzed using appropriate statistical methods with SPSS.Results: Caesarean section (group B) was done in 130 cases (65%) while vaginal delivery (group A) was done in 65 cases (37.5%). Group A had higher maternal mortality (10.7%) in comparison to group B (4.6%) which was statistically not significant (p=0.1075). There were 32 neonatal deaths (24.6%) and 11 still births (8.46%) in group A while there were 12 neonatal deaths (18.46%) and 3 still births (4.61%) in group B. There was a statistically significant difference (p<0.0001) between the groups with respect to total perinatal deaths.Conclusions: Antenatal and intranatal eclampsia should be managed by early termination of pregnancy preferably with Caesarean section. Early presentation and timely decision to terminate pregnancy will improve the maternal and perinatal outcome.

Seizure Disorders

2016 ◽  
pp. 633-638
Author(s):  
Lily C. Wong-Kisiel
Keyword(s):  
Intracranial Pressure ◽  
Brain Tumors ◽  
Behavioral Changes ◽  
Increased Intracranial Pressure ◽  
Primary Brain Tumors ◽  
Seizure Disorders ◽  
Neurologic Deficits ◽  
New Onset

Brain tumors may manifest with focal progressive neurologic deficits, increased intracranial pressure (causing headache, vomiting, and papilledema), new-onset seizures, or progressive cognitive and behavioral changes. The most common primary brain tumors in adults are meningioma, astrocytoma, oligodendroglioma, and lymphoma.

scholarly journals A comparative study of sublingual versus oral misoprostol following oral mifepristone for second trimester termination of pregnancy

2019 ◽  
Vol 8 (2) ◽  
pp. 498
Author(s):  
Ruchi Gupta ◽  
Krishna Priya Banerjee ◽  
Reena Pant
Keyword(s):  
Success Rate ◽  
Medical Abortion ◽  
Oral Route ◽  
Termination Of Pregnancy ◽  
Second Trimester ◽  
Oral Misoprostol ◽  
Sublingual Misoprostol ◽  
Group A ◽  
The Mean ◽  
Group B

Background: The objective of this study is to assess the effectualness and safety of sublingual versus oral misoprostol following oral mifepristone for second trimester termination of pregnancy.Methods: This institution based contingent study was conducted on 220 women requesting for mid-trimester termination of pregnancy between 12-20 weeks with legal indication as per Govt. MTP act. After excluding the women as per exclusion criteria, they were randomly allocated into two groups (Group A Sublingual, Group B Oral), the women received 200 mg oral mifepristone followed by sublingual or oral misoprostol 400µg three hourly for a maximum of 5 doses 48 hours later. The course of misoprostol was reiterated if women failed to abort in 24 hours.Results: The mean induction-abortion interval of Group-A and Group -B was 4.02±1.39 hours and 6.44±1.79 hours respectively. The mean dose of misoprostol in Group–A and Group-B was 680±220.4µg and 1003.6±274.9µg. Hence mean Induction-abortion interval and dose were shortened in  Group-A as compare to Group-B (p <0.05). There was 100% success rate noticed via both routes. Evacuation was done in 4 (3.64%) women in Group-B as compare to only 1 (0.91%) in Group-A . The acceptability was significantly more in Group-B (100%) as compare Group-A (52.73%), probably because of unpleasant taste of sublingual misoprostol. All side effects (Nausea, pain, headache, and diarrhea) were common in both the Groups, only fever was significantly more common in sublingual group as compare to oral group (p<0.05).Conclusions: From present study authors conclude that, sublingual misoprostol when combined with mifepristone is effective for medical abortion in second trimester in terms of effectualness, endurability and success rate than oral route.

scholarly journals Effect of Intraoperative Blood Loss on Perioperative Complications and Neurological Outcome in Adult Patients Undergoing Elective Brain Tumor Surgery

2019 ◽  
Vol 10 (04) ◽  
pp. 631-640 ◽  
Author(s):  
Vanitha Rajagopalan ◽  
Rajendra Singh Chouhan ◽  
Mihir Prakash Pandia ◽  
Ritesh Lamsal ◽  
Girija Prasad Rath
Keyword(s):  
Brain Tumor ◽  
Blood Loss ◽  
Blood Volume ◽  
Perioperative Complications ◽  
Tumor Surgery ◽  
Intraoperative Blood Loss ◽  
Brain Tumor Surgery ◽  
Group A ◽  
Group B ◽  
Group D

Abstract Background Major blood loss during neurosurgery can lead to several complications, including life-threatening hemodynamic instabilities. Studies addressing these complications in patients undergoing intracranial tumor surgery are limited. Materials and Methods During the study period, 456 patients who underwent elective craniotomy for brain tumor excision were categorized into four groups on the basis of estimated intraoperative blood volume loss: Group A (<20%), Group B (20–50%), Group C (>50–100%), and Group D (more than estimated blood volume). The occurrence of various perioperative complications was correlated with these groups to identify if there was any association with the amount of intraoperative blood loss. Results The average blood volume loss was 11% ± 5.3% in Group A, 29.8% ± 7.9% in Group B, 68.3% ± 13.5% in Group C, and 129.1% ± 23.9% in Group D. Variables identified as risk factors for intraoperative bleeding were female gender (p < 0.001), hypertension (p = 0.008), tumor size >5 cm (p < 0.001), high-grade glioma (p = 0.004), meningioma (p < 0.001), mass effect (p = 0.002), midline shift (p = 0.014), highly vascular tumors documented on preoperative imaging (p < 0.001), extended craniotomy approach (p = 0.002), intraoperative colloids use >1,000 mL (p < 0.001), intraoperative brain bulge (p = 0.03), intraoperative appearance as highly vascular tumor (p < 0.001), and duration of surgery >300 minutes (p < 0.001). Conclusions Knowledge of these predictors may help anesthesiologists anticipate major blood loss during brain tumor surgery and be prepared to mitigate these complications to improve patient outcome.

scholarly journals Role of misoprostol 4 hourly versus 6 hourly in medical termination of pregnancy in 2nd trimester.

2021 ◽  
Vol 28 (11) ◽  
pp. 1645-1649
Author(s):  
Komal Devi ◽  
Shazia Aftab ◽  
Reena ◽  
Huma Baloch ◽  
Devi Kumari ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Termination Of Pregnancy ◽  
Ethical Review ◽  
Second Trimester ◽  
Cross Sectional ◽  
Medical Termination Of Pregnancy ◽  
Medical Termination ◽  
Ethical Approval ◽  
Group A ◽  
Group B

Objective: To determine efficacy of misoprostol given in 4 hourly versus 6 hourly intervals in second trimester for termination of pregnancy. Study Design: Cross sectional study. Setting: Study was conducted at the department of Obstetrics and Gynecology of Jinnah Medical and Dental College Karachi Allied Hospital. Period: March to August 2020. Material & Methods: Pregnant ladies in second trimester, requiring abortion due to medical reasons, were planned for termination of pregnancy. Two groups were made. Patients in Group-A were given misoprostol 4 hourly and those in Group-B were given misoprostol 6 hourly. Similar dose of drug (200ug) was given in both groups and monitoring was done. If abortion done in 48 hours, it was considered effective abortion and if not happened in 48 hours, it was considered a failed abortion. Consent was taken from all ladies in study group. Ethical approval was taken from ethical review committee. Results: Total 140 cases were studied, 70 cases in each group, A & B. Age range of cases was 16-40 years with mean age of 26.4±3.5 years. Most of the cases were having age between 20-30 years (63.5%). Group-A (N=70) was given misoprostol 4 hourly, where abortion was done in 94.3% cases while abortion failed in 5.7% cases. In Group-B (N=70) misoprostol was given 6 hourly, induced abortion in 82.8% and failed in 17.1% cases. Conclusion: Misoprostol dose of 20ug given via vaginal route is much effective drug for medical termination of pregnancy when given 4 hourly instead 6 hourly, with low failure rate.

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