Navigating the unthinkable: brain herniation due to glioma after pregnancy termination

BACKGROUND: Brain herniation after pregnancy termination due to glioma diagnosed during pregnancy is an exceptionally rare and potentially debilitating and even fatal condition that poses significant treatment challenges. CASE PRESENTATION: This report presents the case of a 26-year-old pregnant woman who, at 21 weeks of gestation, experienced headache, vomiting, and speech difficulties. Magnetic resonance imaging/magnetic resonance spectroscopy identified a glioma in the left temporal lobe. Following a multidisciplinary consultation, the patient elected to terminate her pregnancy. She was discharged to a local hospital for temporary medical management with intracranial pressure-lowering medications, with a plan to undergo tumour resection after regaining physical strength. The decision to defer surgery was based on the patient's preference to recover physical strength before undergoing tumour resection, rather than on any medical contraindication to immediate surgery. Two weeks after termination, she developed sudden loss of consciousness and left pupillary dilation. Repeat head computed tomography showed marked enlargement of the left temporal lobe glioma, obliteration of the ipsilateral lateral ventricle, and a midline shift to the right. The patient suffered an acute brain herniation, necessitating emergency tumour removal surgery. Postoperative pathological analysis confirmed an isocitrate dehydrogenase (IDH)-mutant astrocytoma (CNS WHO grade 4). Radiotherapy and chemotherapy were administered, and no tumour recurrence was observed over 19 months of follow-up. CONCLUSIONS: Brain herniation is a complex and life‑threatening condition, especially in the context of pregnancy and pregnancy termination. Management of such patients requires close collaboration among a multidisciplinary team including neurosurgeons, obstetricians, anaesthesiologists, and other relevant professionals. Critically, the optimal timing of surgery should be carefully assessed, and tumour resection should be performed as early as clinically feasible. Delaying surgery may lead to irreversible neurological deficits and even life‑threatening consequences. Personalised treatment planswill lead to improved outcomes and a better prognosis.