Surgical Management of Cerebellar Pilocytic Astrocytoma in Pregnancy: A Case Report
Paulo Antonio Ribeiro de Freitas, Raphael Guedes Povoa, Lucas Maia da Costa Eloy Pimenta, Karla Saraiva da Silva, Yuri Reis Casal, Wilker Dias Martins, Alexandre Baldasserini Guimarães, Prospero Lumingo Quedo Mpaca, Ricardo Moscardi, Carlos Gilberto Carlotti Júnior, Eduardo Carvalhal RibasAbstract
Pilocytic astrocytoma (PA) is a rare, typically benign brain tumor classified as a low-grade glioma. Its occurrence during pregnancy is uncommon, but physiological changes in gestation—including hormonal shifts and altered immune and vascular dynamics—may influence tumor behavior, potentially leading to progression or symptom onset. The management of brain tumors in pregnant patients requires careful consideration of both maternal and fetal outcomes.
We report the case of a 17-year-old pregnant patient at 27 weeks' gestation who presented with persistent vomiting and progressive neurological symptoms. The initial hypothesis was hyperemesis gravidarum, followed by subsequent identification of a posterior fossa mass. Brain magnetic resonance imaging (MRI) revealed a cerebellar tumor with obstructive hydrocephalus. Surgical resection via suboccipital craniectomy was performed with favorable maternal and fetal outcomes. Histopathology confirmed a diagnosis of pilocytic astrocytoma. A ventriculoperitoneal shunt was later placed for persistent hydrocephalus. The pregnancy progressed uneventfully, and the patient delivered a healthy infant at term.
This case highlights the importance of early neuroimaging in pregnant patients with atypical or refractory symptoms, as well as the feasibility of neurosurgical intervention in the late second to early third trimester. A multidisciplinary approach is essential to optimize outcomes. Central nervous system (CNS) tumors should be considered in the differential diagnosis of persistent emesis and neurological complaints during pregnancy.