Surreal illustration of a pregnant woman with a glowing brain inside a protective bubble in an operating room.

When Brain Tumors Meet Motherhood: Navigating Cesarean Sections Safely

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Rhea Morgan in Health & Wellness December 2025 • 4 min read.

"A Case Study on Balancing Obstetric and Neurological Risks"


The intersection of pregnancy and pre-existing health conditions presents unique challenges for both patients and healthcare providers. Intracranial neoplasms, or brain tumors, are relatively rare but can significantly complicate pregnancy. Studies suggest an incidence of approximately 21.42 cases per 100,000 people, highlighting the need for specialized care when these conditions overlap with obstetric needs.

Cesarean sections performed under neuraxial anesthesia, such as spinal or epidural blocks, are common in North America due to the benefits of reduced aspiration risk and easier airway management compared to general anesthesia. However, intracranial pathology traditionally poses a contraindication to neuraxial techniques. Concerns arise from the potential for increased intracranial pressure (ICP), reduced cerebrospinal fluid (CSF) flow, and the risk of herniation or neurological deterioration.

This article addresses a challenging case where a patient with a known frontal glioma required a cesarean section. We delve into the decision-making process, focusing on the careful consideration and application of neuraxial anesthesia in light of potential risks. The goal is to provide insights into safely managing such complex cases, balancing the well-being of both mother and child. Consent for publication was obtained from the patient.

The Case: Balancing Risks and Benefits

Surreal illustration of a pregnant woman with a glowing brain inside a protective bubble in an operating room.

A 32-year-old woman (G3P2) at 35 weeks gestation was admitted to the hospital due to decreased fetal movement, a non-reassuring fetal heart rate, and an asthma exacerbation. Her medical history included asthma requiring home nebulizers, morbid obesity (BMI of 53), a known frontal glioma, a seizure disorder, and migraines. She had been hospitalized for asthma exacerbations twice in the previous month, with one instance complicated by pneumonia and sepsis requiring ICU admission.

The patient's history revealed a diagnosis of a low-grade frontal glioma in 2010, discovered after experiencing headaches, nausea, vomiting, and dizzy spells. The glioma was confirmed via biopsy and monitored with serial imaging. The most recent MRI, performed in 2013, showed a stable lesion measuring 2.6 cm x 1.2 cm x 1.1 cm in the right frontal lobe. Notably, there were no signs of increased mass effect or new signal abnormalities, and the midline structures remained centrally located.

  • Comprehensive Assessment: Careful review of the patient’s neurological history, including previous imaging and symptoms.
  • Multidisciplinary Consultation: Collaboration with neurosurgery and obstetrics teams to assess the risks and benefits of different anesthetic approaches.
  • Anesthetic Planning: Consideration of both general and neuraxial anesthesia options, with a focus on minimizing potential complications.
Given the patient's history of a stable glioma, the absence of increased ICP, and the risks associated with general anesthesia (particularly in the context of her asthma exacerbation), a combined spinal-epidural (CSE) technique was chosen. This approach allows for a controlled and gradual onset of anesthesia, reducing the risk of sudden ICP changes. The decision was made in consultation with neurosurgery, who felt neuraxial anesthesia could be safely performed, provided certain precautions were taken.

Conclusion: Personalized Care is Key

Managing a cesarean section in a patient with a known intracranial neoplasm requires a comprehensive and individualized approach. While intracranial pathology has traditionally been considered a contraindication to neuraxial techniques, careful patient selection, thorough assessment, and close collaboration among medical teams can facilitate safe outcomes. This case highlights the importance of balancing the benefits and risks of different anesthetic options to ensure the best possible care for both mother and child.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

1

What exactly is a frontal glioma, and why is it relevant in the context of a cesarean section?

A frontal glioma is a type of brain tumor located in the frontal lobe of the brain. In this case, the patient had a low-grade frontal glioma that was diagnosed in 2010 and monitored with serial imaging. The most recent MRI in 2013 showed a stable lesion without signs of increased mass effect or new abnormalities. Gliomas, in general, can be problematic during pregnancy due to potential increases in intracranial pressure and other neurological risks.

2

What is neuraxial anesthesia, and why is it typically a concern for patients with brain tumors?

Neuraxial anesthesia, such as spinal or epidural blocks, is a technique used during cesarean sections to provide pain relief while allowing the patient to remain awake. It involves injecting anesthetic agents near the spinal cord. Traditionally, intracranial pathology has been considered a contraindication to neuraxial techniques due to concerns about increasing intracranial pressure (ICP), reducing cerebrospinal fluid (CSF) flow, and the risk of herniation or neurological deterioration. However, in certain cases, with careful consideration and monitoring, it can be safely used.

3

Can you explain what intracranial pressure (ICP) is and why it's important when discussing anesthesia options for someone with a brain tumor?

Intracranial pressure (ICP) refers to the pressure inside the skull, surrounding the brain. Elevated ICP can be dangerous, especially in individuals with brain tumors, as it can lead to herniation and neurological damage. Concerns about increased ICP are a primary reason why neuraxial anesthesia has traditionally been avoided in patients with intracranial pathology. In the case described, the patient's stable glioma and absence of increased ICP allowed for the consideration of neuraxial anesthesia under careful monitoring.

4

What is a combined spinal-epidural (CSE) technique, and why was it considered in this particular case?

A combined spinal-epidural (CSE) technique involves administering a spinal anesthetic for rapid pain relief followed by an epidural catheter for continuous pain management. This approach allows for a controlled and gradual onset of anesthesia, reducing the risk of sudden intracranial pressure (ICP) changes. In the described case, CSE was chosen to minimize potential complications associated with general anesthesia, given the patient's history of asthma exacerbations.

5

What does a multidisciplinary consultation involve, and why is it so important in managing a patient with both a brain tumor and obstetric needs?

A multidisciplinary consultation involves collaboration between different medical specialists, such as neurosurgery and obstetrics teams. This collaboration is crucial in managing complex cases like the one described, where a patient with a brain tumor requires a cesarean section. By pooling their expertise, the teams can assess the risks and benefits of different anesthetic approaches and develop a personalized care plan to ensure the best possible outcome for both mother and child.

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