Tuberculum sellae meningioma growing during pregnancy: A difficult decision-making process

A 43-yr-old woman presented to us 32 wk into her second pregnancy with a 2-wk history of progressive visual impairment (consisting of bitemporal emianopia and visual acuity decrease to 1/10 in the left eye and 4/10 in the right eye) due to a tuberculum sellae meningioma (TBM) (Fig. 1A). The diagnosis was based on the presence of typical radiological features of a meningioma overlying a normal-sized sella with a preserved pituitary gland. She was given oral dexamethasone to accelerate the fetal lung maturation. A healthy boy was born at 34 wk gestation by cesarean section. After delivery, visual disturbances did not improve, and the patient underwent an endoscopic transsphenoidal transplanum/transtuberculum approach (ETTA), obtaining radical removal of the meningioma. Histological examination showed a meningotheliomatous meningioma with marked expression of progesterone receptors (Fig. 2). The postoperative course was uneventful, and she was discharged home on d 5 with complete recovery of her visual function. The patient did not show hypothalamic/pituitary dysfunction during or after pregnancy. Three months later, magnetic resonance imaging confirmed the radical removal of the tumor (Fig. 1B). When last seen 5 months after surgery, she was in good clinical condition. To our knowledge, 13 other cases of TBM growing during pregnancy have been reported (1–4), but our patient was the first to be treated by ETTA, a minimally invasive approach that favored a prompt return home of the mother to her child. The high expression of progesterone receptor in the specimen (Fig. 2) confirms the physiopathological mechanism suggested by other authors to explain the rapid growth of the tumor during pregnancy (1–4). Interestingly, supporting this hypothesis, regression of multiple intracranial meningiomas after discontinuation of long-standing use of megestrol acetate has been recently reported (5).