Brainstem Glioma in Pregnancy

INTRODUCTION: Information on pregnancy outcomes in women with brainstem glioma during pregnancy is limited to case reports. METHODS: We conducted a systematic review in accordance with PRISMA guidelines and registered with the PROSPERO website (CRD42017060196). Four databases were searched using appropriate indexing terms. Quality assessment was performed in duplicate using the Joanna Briggs Institute Critical Appraisal Checklist for case reports. Outcomes were reported as proportions. RESULTS: We identified 2726 titles and abstracts of which 89 full texts were screened and 12 articles describing 17 pregnancies in 16 women were included. Most studies had a low or moderate risk of bias. Of the 14 (82.4%) antenatal diagnoses, 10 (58.8 %) were made in the second trimester. Clinical presentation included headaches, nausea and vomiting, focal neurological findings and sudden death. Antenatal treatment included surgical resection in four women, radiation in three and endoscopic third ventriculostomy in one. Postpartum treatment included surgical resection and radiation in two women each. Of the eight maternal deaths (47.1%), five were in the antenatal period, and three were within four months of delivery. Follow up was available for six of the eight survivors, for a median of 24 months, during which time two (33.3%) deteriorated. Fetal outcomes included 4/17 (23.5%) losses secondary to maternal demise, one therapeutic abortion and 5/12 (41.7%) preterm deliveries (median 34 weeks, interquartile range 6). CONCLUSION: Prognosis for women with brainstem glioma remains guarded despite multidisciplinary care in tertiary-level centers and prompt attention to diagnosis and treatment. In survivors, fetal outcomes are reassuring.