Rome – A pregnant woman with a large meningioma underwent delicate neurosurgery to remove the tumor, while the fetus was kept in the uterus and monitored throughout the operation.
After weeks of complex treatment, with a very rapid recovery for such a case, the mother and baby—who was born prematurely—are doing well. This exceptional operation, of which only a few are known worldwide, was performed by a multidisciplinary team at Sant'Eugenio Hospital in Rome, involving neurosurgeons led by the head physician, Dr. Stefano Signoretti, anesthesiologists led by Dr. Massimo Galletti, gynecologists led by Dr. Fabrizio Signore, and neonatologists led by Dr. Camilla Gizzi.
“We were faced with a truly exceptional case,” Dr. Signoretti told Dire, “both for the volume of the tumor, equal to little more than half a can of cola, and for the particular condition of the patient, a young woman in her twenty-seventh week of pregnancy.
Meningiomas are benign tumors, but during pregnancy they can grow rapidly because they are stimulated by the hormones estrogen and progesterone: the longer you wait, the larger they become, feeding on the same hormones the fetus needs in its final months. When we were called, the patient had vague symptoms and the fetus was doing well, but we decided to monitor her closely.
Within 24 hours, two epileptic seizures occurred, a clear sign that intervention was necessary. Our primary goal is always to save the mother, but in this case, we also had to protect the baby. During the procedure, we had a double heartbeat in the operating room, something that doesn't happen often. The fetus tolerated the anesthesia surprisingly well and recovered immediately when the mother was awakened. It was a work that involved neonatologists, anesthesiologists, and gynecologists: a true team on the same lifeboat.
The surgery, which normally takes 6-7 hours, was completed in 4 and a half hours, thanks also to the patient's young age and the quality of her tissues.
The post-operative phase now remains. "Freeing a volume the size of a tennis ball," emphasizes the head of Neurosurgery, "means asking the brain to readjust. Today we can say that the baby is doing well and that the mother, discharged yesterday, has begun her rehabilitation program. This is an achievement that fills us with pride."
Also commenting on the case with Dire was the head of Gynecology at Sant'Eugenio. The patient, in the 26th-27th week of pregnancy, presented symptoms
Initially attributable to obstetric conditions, an MRI revealed a frontal meningioma measuring approximately 8 cm. As the pregnancy progressed, around the 29th or 30th week, the tumor began compressing important brain structures, causing maternal decompensation that required urgent neurosurgical intervention.
The clinical decision was to keep the fetus in utero, ensuring the greatest possible safety. Throughout the entire long and delicate operation, the baby was constantly monitored by a multidisciplinary team. Fetal parameters remained stable, allowing the neurosurgeon to proceed with the removal of the large meningioma.
In the immediate post-operative period, the fetus continued to show good reactivity and cardiac stability, a crucial finding given the mother's condition. However, a few weeks later, a new heart failure occurred, this time also obstetric, which made delivery necessary. The baby was born very prematurely, weighing approximately 1,5 kg, and was admitted to the neonatal intensive care unit. Today, the baby is no longer intubated, is breathing independently, and can receive visits from his mother.
Despite the complexity and rarity of the case, both the baby and the mother are doing well, thanks to the coordinated and timely intervention of all the teams involved.
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