When Brain Tumors Meet Motherhood: Navigating Cesarean Sections Safely
"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.
Cesarean Decisions and Anesthetic Considerations
FIGO’s 2023 good-practice recommendations present evidence-based surgical techniques intended to reduce cesarean-associated complications. For pregnant patients with glioma, a 2024 review reports that cesarean delivery offers no advantage over attempted vaginal delivery and emphasizes multidisciplinary management. A separate article describes general anesthesia with agents such as thiopental or propofol and controlled ventilation as a traditional approach for cesarean delivery in patients with brain tumors.
A Brief History of Cesarean Section
The National Library of Medicine’s “Cesarean Section - A Brief History” exhibit is organized into a preface, four parts, and references. Jane Eliot Sewell presented “Cesarean Section--A Brief History” in 1993 as a brochure for the NLM exhibit in Bethesda, Maryland. The brochure defines a cesarean section as a surgical procedure to deliver a fetus through an incision in a pregnant person’s abdomen.
The Case: Balancing Risks and Benefits
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.
- 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.
Recent Reports on Glioma and Pregnancy
A case report describes a parturient with glioma and raised intracranial pressure who underwent cesarean delivery under general anesthesia, followed immediately by craniotomy. A 2024 review reports that cesarean delivery does not offer an advantage over attempted vaginal delivery for pregnant patients with glioma and recommends multidisciplinary care. A 2025 report describes treatment of a pregnant patient with grade IV glioblastoma using intralesional carmustine (Gliadel) chemotherapy during pregnancy; another 2025 report discusses a WHO grade 4 astrocytoma that recurred during pregnancy and notes the scarcity of published cases.
Evidence Gaps in Managing Glioma During Pregnancy
A systematic review reports that the low incidence of glioma in pregnancy means evidence on outcomes and management has relied on small case series and expert opinions. A 52-case multicenter series classifies its evidence as Class IV and strongly advises a multidisciplinary approach. Separately, the Response Assessment in Neuro-Oncology criteria were developed as an objective tool for assessing treatment response in high-grade gliomas, while imaging interpretation can remain challenging, including after surgery or radiation.
Reported Incidence in Pregnancy
A review of two third-trimester glioma cases cites a study reporting maternal malignant brain tumors at 3.6 per 1 million live births. This figure is the incidence reported by that cited study, not a comparison of delivery methods or outcomes. The source’s focus is two cases and a review of the literature.
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.
Emerging Research Directions
A 2025 review of artificial intelligence in glioma research analyzes contributors, influential journals, emerging research hotspots, and temporal trends, and discusses how AI-assisted methods intersect with traditional glioma management. A 2024 review of clinical immunotherapy in glioma summarizes recent approaches, the status of clinical trials, and challenges and prospects. A 2024 editorial on glioma invasion discusses the field’s current status and future research directions toward clinically effective therapy against GBM invasion.