Vestibular Schwannomas in Pregnancy: A Case Series.

Objectives: Vestibular schwannomas (VS) are benign intracranial tumors, the majority of which are indolent and managed conservatively with active surveillance. VS during pregnancy is rare and poorly understood. It is unclear whether hormonal changes during pregnancy contribute to VS growth. Currently, the largest case series describing VS during pregnancy comprises six cases from the Mayo Clinic in 1993, where they note that tumors tend to be larger and associated with higher surgical morbidity. We present five further cases of peripartum VS and their management strategies. Design: A retrospective review of 540 consecutive patients with sporadic VS at St George's Hospital from 2017 to 2023 was performed. Setting: St George's Hospital is a tertiary hospital in London providing joint neurosurgical and ENT management of VS. Participants: A total of 280 out of 540 patients were female (52%), and 5 were either pregnant at presentation or had given birth within 6 months of presentation (1%). Main Outcome Measures: Maternal/infant well-being, postoperative complications, and facial nerve function were our main outcome measures. Results: All patients had tumors >30 mm requiring translabyrinthine resection. One underwent VS resection with intraoperative lactation breaks 1 week following elective cesarean section. Two required cerebrospinal fluid (CSF) shunts to delay resection. One had her resection while 21 weeks pregnant. All had intact postoperative facial nerve function and healthy babies. One experienced a CSF leak requiring a lumbar drain. Conclusion: Because pregnancy tends to be associated with large tumors and surgery is complicated by obstetric considerations, appropriate counselling should be given to women of childbearing age.