Background: Central nervous system (CNS) tumors during pregnancy are rare but present significant diagnostic, therapeutic, and ethical challenges. These include both primary and metastatic lesions, which share overlapping clinical features and management complexities. Their clinical course is influenced by gestational physiological changes, which can mask symptoms and delay diagnosis, thereby increasing maternal and fetal risks. Objective: This review aims to synthesize current evidence on the epidemiology, pathophysiology, clinical presentation, diagnostic strategies, treatment options, prognosis, and ethical considerations related to CNS tumors in pregnant patients. Methods: A comprehensive literature review was conducted, including retrospective and prospective studies, clinical guidelines, and systematic reviews focusing on brain and spinal tumors diagnosed during pregnancy. Particular attention was given to the impact of gestational age, tumor histology, and maternal condition on treatment outcomes. Results: Hormone-sensitive tumors such as meningiomas and prolactinomas may exhibit accelerated growth during pregnancy due to elevated progesterone and prolactin levels. Diagnosis is often delayed due to symptom overlap with normal gestational changes. MRI without contrast remains the imaging modality of choice. Glucocorticoids and selected chemotherapy agents can be cautiously used depending on gestational age. Surgical resection, particularly in the second trimester, has been shown to be safe and effective in appropriate clinical scenarios. Multidisciplinary coordination is essential. Prognosis varies based on tumor type and timing of intervention, with maternal survival prioritized in high-risk situations. Ethical management hinges on patient autonomy, informed consent, and proportionality of medical interventions. Conclusions: CNS tumors during pregnancy require early recognition, individualized treatment planning, and ethical vigilance. Multidisciplinary collaboration is vital to optimizing outcomes for both mother and fetus. Future efforts should focus on developing standardized protocols and expanding evidence through multicenter studies.
背景：妊娠期中枢神经系统肿瘤虽属罕见，但给临床诊断、治疗及伦理决策带来重大挑战。此类病变包括原发性和转移性肿瘤，其临床表现存在重叠且管理复杂。妊娠期生理变化可能掩盖症状并延误诊断，从而影响疾病进程，增加母婴风险。 目的：本文旨在综合当前关于妊娠期中枢神经系统肿瘤的流行病学、病理生理学、临床表现、诊断策略、治疗方案、预后评估及伦理考量的研究证据。 方法：通过系统文献回顾，纳入回顾性与前瞻性研究、临床指南及针对妊娠期脑与脊髓肿瘤的系统综述，重点关注孕周、肿瘤组织学特征及母体状况对治疗结局的影响。 结果：激素敏感性肿瘤（如脑膜瘤与泌乳素瘤）在妊娠期可能因孕激素和泌乳素水平升高而加速生长。由于症状与正常妊娠变化重叠，诊断常被延误。非增强磁共振成像仍是首选影像学检查手段。根据孕周可谨慎使用糖皮质激素及特定化疗药物。在适宜的临床情境中，手术切除（尤其于妊娠中期）被证实安全有效。多学科协作至关重要。预后因肿瘤类型与干预时机而异，高危情况下应以保障母体生存为优先。伦理管理的核心在于尊重患者自主权、获取知情同意及医疗干预的相称性原则。 结论：妊娠期中枢神经系统肿瘤需要早期识别、个体化治疗规划及伦理审慎决策。多学科协作对优化母婴结局至关重要。未来应致力于制定标准化诊疗方案，并通过多中心研究进一步积累证据。
Brain Tumors in Pregnancy: A Review of Pathophysiology, Clinical Management, and Ethical Dilemmas
肿瘤(癌症)患者之家