Management of Giant Vestibular Schwannoma in Second Trimester Pregnancy – Review of Literature

Vestibular schwannoma is considered as the one of the most common primary brain tumor in middle age group especially in females, however incidence is extremely uncommon. Although surgical management of giant vestibular schwannoma (GVS) in non-pregnant state is associated with high morbidity and mortality. However, in the recent years more and more surgeons prefer surgical management with relatively better outcome. Pregnancy is associated with hormonal changes, systemic changes and increased circulatory volume and associated hypertension, latent diabetes mellitus, pre-eclampsia further complicate the surgical management in the pregnancy. As anaesthetic medication and surgical procedure should not put stress on either mother as well as developing foetus and ideally pregnancy should continue till expected date of delivery and normal delivery of foetus at term should be aim. There is no definite line of management due to paucity of literature as most of authors suggested initial CSF diversion surgery in view of considering added risk as surgical management of GVS itself is associated with very high morbidity and complications rate, and pregnancy further aggravates the risk concerning not only to the pregnant women but also live foetus, and considering these, primary surgical management were usually deferred till few weeks following delivery of the baby or rarely Caeserian section for foetus delivery consecutively followed by resection of GVS was reported. Authors report an extremely rare case of giant vestibular schwannoma in pregnancy, who underwent retromastoid craniectomy in second trimester, she tolerated surgery very well and pregnancy continued with single live foetus, baby was delivered normally at term. Foetus had no congenital malformation. To the best of knowledge of authors, current case is first case in literature, which underwent successful giant Vestibular schwannoma excision with continuation of pregnancy with healthy live foetus. Authors briefly discuss natural history, operative procedure, timing of surgery, management of vestibular schwannoma in pregnancy with aim to monitor foetal well being and outcome and pertinent review of literature.