Pregnancy-Associated Acceleration of Meningiomas: A Case Series of Three Patients

Introduction: Meningiomas are generally indolent, but their growth can be influenced by hormonal, vascular, and metabolic changes. Pregnancy presents a unique milieu of elevated progesterone, increased blood volume, and tissue edema, which may accelerate tumor progression and worsen mass effect. Although pregnancy-associated meningioma growth is rare, it presents significant diagnostic and management challenges due to risks for both mother and fetus. We present three illustrative cases demonstrating symptomatic meningioma progression during pregnancy, emphasizing clinical presentation, radiographic evolution, operative management, and pathology. Methods: A retrospective review was performed of three women with meningiomas whose growth was temporally associated with pregnancy. Clinical presentation, imaging, operative details, histopathology, and outcomes were extracted from the medical record and analyzed. Results: Case 1: A 40-year-old multiparous woman presented postpartum with mild visual blurring. Imaging revealed an enlarging right paraclinoid mass that had demonstrated interval growth following pregnancy. She underwent right frontotemporal craniotomy with anterior clinoidectomy. Pathology showed meningothelial meningioma, WHO grade I, with progesterone receptor positivity and PIK3CA mutation. She recovered without deficit and remains radiographically disease-free. Case 2: A 33-year-old gravida 2 presented at 37 weeks gestation with progressive left hemifacial numbness, frequent epistaxis, and a palpable facial mass. MRI revealed a 4 × 3 × 4 cm left spheno-cavernous meningioma extending through the skull base with ICA encasement. Subtotal resection was achieved via pterional craniotomy; pathology confirmed WHO grade I mixed fibrous/meningothelial meningioma with low proliferative index (Ki-67