Visual Deterioration during Pregnancy due to Tumors Involving the Optic Apparatus: Management Algorithm and Our Experience in Nine Patients

Introduction: There is a tendency toward tumor growth during pregnancy because of immunologic, hormonal, and fluid shifts. When the tumor abuts the optic apparatus, tumor growth may cause visual deterioration. Decisions involving treatment of these tumors should take into consideration visual function, fetal and maternal safety, and the ability for total resection of the tumor.

Methods: A retrospective case-series review was conducted. Nine women were diagnosed during pregnancy. Neurosurgical as well obstetrical data were collected from the patients' hospital and outpatient clinic records as well as operative notes, obstetric reports, and pre- and postoperative imaging studies.

Results: Nine patients underwent neurosurgical intervention—four women during pregnancy and five women after delivery. All women delivered at 34–40 weeks gestation. Outcome for all neonates was good. Improvement in visual acuity and visual fields was achieved in seven patients, while there was no change in the two who presented with eye movement disorders. There were two cases of CSF leak that resolved with a continuous drainage spinal catheter (CD) or endoscopic sealing.

Conclusions: Visual deterioration during pregnancy due to tumors involving the optic apparatus requires a unique set of treatment decisions using a multidisciplinary approach. Surgery is well tolerated during pregnancy and, if visual changes are present, delay of surgery is not justified as it may result in further visual deterioration and emergent intervention associated with increased maternal and fetal risk. We had good neurologic outcome and excellent obstetric results following these guidelines.