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What should you do if cerebral hemangioma occurs during pregnancy?

What should you do if cerebral hemangioma occurs during pregnancy? In most case studies, the mortality of pregnant women caused by subarachnoid hemorrhage is 30%-50%, but it is also reported as high as 83%.

Cerebrovascular disease during pregnancy and puerperium is rare, but once it occurs, it can be catastrophic for the mother and fetus.

0.67% of all women of childbearing age give birth to children each year. The precise incidence of cerebrovascular disease during pregnancy is uncertain, and it is estimated to range from 0.3-9 cases per 10,000 births; the reason why the estimated value varies so widely may be due to the different query patterns and childbearing age The overall incidence of cerebrovascular disease in the population is low.

But among the death causes of pregnant women, 12% and 80% are caused by cerebrovascular disease.

Cerebrovascular disease during pregnancy will cause higher mortality and mortality of pregnant women and fetuses than those of non-pregnant women of the same age.

The most common cerebrovascular diseases that endanger pregnant women include aneurysm subarachnoid hemorrhage, intracranial hemorrhage from hemangioma, and ischemic stroke secondary to arterial blockage or intracranial vein thrombosis.

Other pregnancy-related vascular diseases include tumor hemorrhage, secondary metastatic choriocarcinoma, cavernous sinus-carotid fistula, and intracranial hemorrhage from pituitary stroke.

Physiological changes during pregnancy, the needs of the mother and the fetus, and pregnancy-specific diseases will bring special problems to neurosurgeons who treat cerebrovascular diseases in pregnancy.

The diagnosis and treatment of cerebrovascular diseases during pregnancy have undergone tremendous changes.

New radiographic techniques and advances in cerebrovascular surgery allow neurosurgeons to better meet the needs of pregnant patients.

Precautions for pharmacology

Physiological changes in pregnancy will change the pharmacokinetics of most drugs. Throughout the pregnancy, drug absorption, metabolism, clearance, protein binding, and volume of distribution are constantly changing. Many drugs commonly used in neurosurgery may have adverse effects on the fetus.

Precautions for surgery

The change of lung mechanical properties is of great significance to the implementation of anesthesia. The increase in alveolar minute ventilation will cause faster induction of anesthesia, the minimum anesthetic concentration will be reduced by 25%40%, and the risk of inhaled anesthetics will increase.

Moreover, the typical situation caused by physiological hyperventilation during pregnancy is that PaCO2 is only 32mmHg, but the pH is normal.

Umbilical vessels are very similar to cerebrovascular vessels, and are sensitive to pH changes and are susceptible to hyperventilation. These factors should be considered when using hyperventilation during surgery or when dealing with increased intracranial pressure.

In any operation of pregnant women, the abdominal Doppler probe must be used to continuously monitor the fetal heart rate. Tachycardia and disappearance of normal heart rate variability are early signs of fetal distress. Fetal bradycardia indicates more severe maternal hypotension and uterine hypoperfusion.

Patients usually use the supine position during craniotomy. However, if pregnant women adopt the supine position at term, more than 90% of their inferior vena cava will be completely blocked due to uterine compression. Obstruction can cause maternal and fetal hypotension, but as long as the patient is placed on the side during the operation, this situation can be eliminated.

The moderate hypothermia during vascular surgery helps to protect the brain, and it can be well tolerated by both the mother and the fetus in practical applications. In the craniotomy of vascular disease, controlled hypotension is helpful. Particular care should be taken when taking measures to lower the maternal blood pressure, because the uterine perfusion cannot be self-regulated, and hypoperfusion will occur when the maternal hypotension occurs.

Isoflurane anesthesia can be used for 5 stages of controlled hypotension, and it will not be accompanied by a significant drop in uterine blood flow. Although some animal studies have shown that sodium nitroprusside can penetrate the placenta and cause cyanide deposition in the fetus, the drug has also been successfully used in aneurysm surgery.

Conclusion

In most case studies, the mortality of pregnant women caused by subarachnoid hemorrhage is 30%-50%, but it is also reported as high as 83%.

Dis and Sekhar8 concluded that the overall maternal mortality rate due to aneurysm subarachnoid hemorrhage is 35%, which is similar to the proportion of non-pregnant people. The fetal mortality rate is 17%.

Maternal mortality after subarachnoid hemorrhage is directly related to clinical grade (Hunt and Hess), and the mortality of patients with Hunt and Hes is the highest.

The mortality rate (11%) of pregnant women who underwent prenatal surgery to treat ruptured aneurysm was significantly lower than that of patients without surgery (63%).

Fetal mortality after surgery (5%) is also significantly better than that of patients without surgery (27%).

(source:internet, reference only)

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