Skip to main content
SpringerLink
Log in

Multidisciplinary team efforts improve the surgical outcomes of sellar region lesions during pregnancy

  • Endocrine Surgery
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Purpose

Treatment of space-occupying lesions (SOLs) in the sellar region is a clinical challenge, especially in pregnant women because many treatment decisions are restrained due to pregnancy. We attempt to discuss the surgical indications and timing for pregnant patients and highlight the importance of multidisciplinary team (MDT) treatment.

Methods

From August 2017 to February 2018, four pregnant women were admitted to our hospital with severe visual impairment due to sellar region SOLs, including two cases of tuberculum sellae meningioma, one case of giant pituitary adenoma and one case of a pituitary abscess. All four patients were safely treated by surgery during the second and third trimesters of pregnancy through concerted efforts of the MDT, including a neurosurgeon as the team leader in combination with experts in obstetrics, ophthalmology and endocrinology.

Results

The SOLs were removed completely from all four patients, resulting in significantly improved vision without operation-related complications. Pregnancy continued postoperatively to full-term delivery in three of the four patients. The other patient with a pituitary abscess selected to terminate the pregnancy at a gestational age of 20 weeks because of her own concerns. The four babies (including a pair of twins) were born healthy and had developed normally at the 6-week postpartum follow-up.

Conclusions

With the MDT guiding the decision-making process, surgical resection of sellar region SOLs in pregnant women with severe visual impairment is practical to improve the prognosis without affecting the outcomes of pregnancy for either the mother or the infant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. W. Saeger, D.K. Ludecke, M. Buchfelder, R. Fahlbusch, H.J. Quabbe, S. Petersenn, Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur. J. Endocrinol. 156(2), 203–216 (2007). https://doi.org/10.1530/eje.1.02326

    Article  CAS  PubMed  Google Scholar 

  2. H.C. Kim, S.G. Kang, P.W. Huh, S. Yoo do, K.S. Cho, D.S. Kim, Pituitary abscess in a pregnant woman. J. Clin. Neurosci. 14(11), 1135–1139 (2007). https://doi.org/10.1016/j.jocn.2006.03.012

    Article  PubMed  Google Scholar 

  3. S. Shitara, N. Nitta, T. Fukami, K. Nozaki, Tuberculum sellae meningioma causing progressive visual impairment during pregnancy. Neurol. Med Chir. 52(8), 607–611 (2012)

    Article  Google Scholar 

  4. O.E. Idowu, M.T. Shokunbi, S.D. Amanor-Boadu, O.A. Roberts, C. Eyo, Surgical management of tuberculum sellae meningioma in a patient with a twin pregnancy: case report. Surg. Neurol. 62(1), 60–63 (2004). https://doi.org/10.1016/j.surneu.2003.07.007

    Article  CAS  PubMed  Google Scholar 

  5. E. Grillo-Mallo, J. Jimenez-Benito, E. Diez-Feijoo, I. Alonso Alonso, A. Ferrero Collado, S. Munoz Quinones, [Acute visual loss in pregnancy caused by craniopharyngioma]. Arch. Soc. Esp. Oftalmol. 89(4), 152–156 (2014). https://doi.org/10.1016/j.oftal.2012.09.016

    Article  CAS  PubMed  Google Scholar 

  6. A. Tandon, J. Alzate, P. LaSala, M.P. Fried, Endoscopic endonasal transsphenoidal resection for pituitary apoplexy during the third trimester of pregnancy. Surg. Res Pract. 2014, 397131 (2014). https://doi.org/10.1155/2014/397131

    Article  PubMed  PubMed Central  Google Scholar 

  7. B.H. Priddy, B.A. Otto, R.L. Carrau, D.M. Prevedello, Management of skull base tumors in the obstetric population: a case series. World Neurosurg. 113, e373–e382 (2018). https://doi.org/10.1016/j.wneu.2018.02.038

    Article  PubMed  Google Scholar 

  8. M. Zoli, M. Faustini-Fustini, D. Mazzatenta, E. Pasquini, G. Frank, Tuberculum sellae meningioma growing during pregnancy: a difficult decision-making process. J. Clin. Endocrinol. Metab. 97(5), 1418–1419 (2012). https://doi.org/10.1210/jc.2012-1155

    Article  CAS  PubMed  Google Scholar 

  9. P. Witek, G. Zielinski, M. Maksymowicz, W. Zgliczynski, Transsphenoidal surgery for a life-threatening prolactinoma apoplexy during pregnancy. Neuro Endocrinol. Lett. 33(5), 483–488 (2012)

    PubMed  Google Scholar 

  10. S. Moscovici, S. Fraifeld, J.E. Cohen, S. Dotan, U. Elchalal, Y. Shoshan, S. Spektor,, Parasellar meningiomas in pregnancy: surgical results and visual outcomes. World Neurosurg. 82(3–4), e503–e512 (2014). https://doi.org/10.1016/j.wneu.2013.06.019

    Article  PubMed  Google Scholar 

  11. E. Lioret, P. Francois, C. Hommet, [Tumors of the neuraxis and neuraxial sheaths during pregnancy (excluding tumors of the sellar region)]. Neurochirurgie 46(2), 76–87 (2000)

    CAS  PubMed  Google Scholar 

  12. C. Zoia, A. Cattalani, E. Turpini, V.M. Custodi, M. Benazzo, F. Pagella, P. Carena, E. Lovati, P. Lucotti, P. Gaetani, Haemorrhagic presentation of a craniopharyngioma in a pregnant woman. Case Rep. Neurol. Med. 2014, 435208 (2014). https://doi.org/10.1155/2014/435208

    Article  PubMed  PubMed Central  Google Scholar 

  13. B. Vizner, J. Talan-Hranilovic, Z. Gnjidic, M. Sekso, M. Berkovic, V. Altabas, Z. Rumboldt, Lymphocytic adenohypophysitis simulating a pituitary adenoma in a pregnant woman. Coll. Antropol. 26(2), 641–650 (2002)

    CAS  PubMed  Google Scholar 

  14. S. Sakatsume, T. Kawataki, M. Ogiwara, H. Sato, H. Kinouchi, [Spontaneous improvement in visual symptom after delivery in a case of tuberculum sellae meningioma]. No Shinkei Geka 46(7), 607–613 (2018). https://doi.org/10.11477/mf.1436203777

    Article  PubMed  Google Scholar 

  15. J.G. Chacko, J.L. Miller, E.J. Angtuaco, Spontaneous postpartum resolution of vision loss caused by a progesterone receptor-positive tuberculum sellae meningioma. J. Neuroophthalmol. 30(2), 132–134 (2010). https://doi.org/10.1097/WNO.0b013e3181da9d59

    Article  PubMed  Google Scholar 

  16. D. Grkovic, T. Bedov, [Outcome of visual acuity after surgical removal of pituitary adenomas]. Srp. Arh. Celok. Lek. 141(5–6), 296–303 (2013)

    Article  Google Scholar 

  17. A. Atmaca, S. Dagdelen, T. Erbas, Follow-up of pregnancy in acromegalic women: different presentations and outcomes. Exp. Clin. Endocrinol. Diabetes 114(3), 135–139 (2006). https://doi.org/10.1055/s-2005-873004

    Article  CAS  PubMed  Google Scholar 

  18. F.H. Ebner, A. Bornemann, H. Wilhelm, U. Ernemann, J. Honegger, Tuberculum sellae meningioma symptomatic during pregnancy: pathophysiological considerations. Acta Neurochir. 150(2), 189–193 (2008). https://doi.org/10.1007/s00701-007-1417-5. discussion 193

    Article  CAS  PubMed  Google Scholar 

  19. E.M. Kasper, P.E. Hess, M. Silasi, K.H. Lim, J. Gray, H. Reddy, L. Gilmore, B. Kasper, A pregnant female with a large intracranial mass: reviewing the evidence to obtain management guidelines for intracranial meningiomas during pregnancy. Surg. Neurol. Int 1, 95 (2010). https://doi.org/10.4103/2152-7806.74242

    Article  PubMed  PubMed Central  Google Scholar 

  20. J. Pallud, H. Duffau, R.A. Razak, P. Barbarino-Monnier, L. Capelle, D. Fontaine, M. Frenay, F. Guillet-May, E. Mandonnet, L. Taillandier, Influence of pregnancy in the behavior of diffuse gliomas: clinical cases of a French glioma study group. J. Neurol. 256(12), 2014–2020 (2009). https://doi.org/10.1007/s00415-009-5232-1

    Article  PubMed  Google Scholar 

Download references

Funding

This study was funded by Shanghai Science and Technology Commission and Program of Shanghai Academic Research Leader (ZBW) (grant number: 18XD1403400).

Author information

Author notes

  1. These authors contributed equally: Hui Ping Zhong, Hao Tang, Yong Zhang

Authors and Affiliations

  1. Department of Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Hui Ping Zhong

  2. Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Hao Tang, Yong Zhang, Hong Yao, Wei Ting Gu, Yong Xu Wei & Zhe Bao Wu

  3. Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Yan Luo

  4. Department of Ophthalmology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Yu Cheng

Authors
  1. Hui Ping Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hao Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yan Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hong Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yu Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wei Ting Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yong Xu Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zhe Bao Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhe Bao Wu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhong, H.P., Tang, H., Zhang, Y. et al. Multidisciplinary team efforts improve the surgical outcomes of sellar region lesions during pregnancy. Endocrine 66, 477–484 (2019). https://doi.org/10.1007/s12020-019-02054-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-019-02054-0

Keywords

Search

Navigation