Clinical decision-making and management of gliomas in the second trimester: case series report

Glioma during pregnancy is uncommon, and evidence regarding the optimal timing for tumor resection and whether to continue the pregnancy is limited. Advances in the pathology of gliomas have improved clinicians’ ability to assess prognosis. All three patients were diagnosed with glioma during the second trimester and presented with definite surgical indications. Case 1 underwent emergency surgery for impaired consciousness and achieved gross total resection (100%). Pathology revealed a WHO grade 3 oligodendroglioma in the right frontal lobe. Concurrent radiotherapy and temozolomide (RT/TMZ) commenced after she delivered a healthy infant at 34 weeks gestation. Case 2 presented with epilepsy, and her MRI revealed a large tumor in the left frontal lobe. Intraoperative MRI confirmed an extent of resection (EOR) of 87.3%. Pathology confirmed an isocitrate dehydrogenase (IDH)-mutant astrocytoma, WHO grade 3. Speech and motor functions remained intact after surgery. She underwent RT/TMZ following delivery at 37 weeks gestation. Case 3 presented with numbness in the right limb. Examination revealed a massive tumor involving the left thalamus, midbrain, and lateral ventricles. Under intraoperative MRI guidance, EOR reached 95.2% while preserving the patient’s speech and motor functions. The pathological diagnosis was IDH wild-type diffuse midline glioma (DMG) with H3 K27 mutation, WHO grade 4. She underwent induced abortion at 17 weeks gestation and started RT/TMZ as early as possible. It is possible to achieve satisfactory resection of a large glioma diagnosed during the second trimester without terminating the pregnancy. Given the rarity and complexity of these cases, personalized recommendations from the multidisciplinary team (MDT) and shared decision-making with patients are crucial.