Neurosurgery in pregnancy.

Neurosurgical disorders are a significant cause of nonobstetric death and disability in pregnant women. The most common neurosurgical conditions encountered are intracranial hemorrhage, hydrocephalus, intracranial tumors, disc rupture, and head trauma. With modern anesthesia techniques, life-threatening problems can be very well handled with minimal danger to the fetus. However, it is preferable to wait until the third trimester if possible to do semielective surgery. Intracranial hemorrhage can sometimes be followed conservatively if it is not life-threatening; shunted hydrocephalus may get worse during the later stages of pregnancy but can usually be followed; meningiomas and pituitary adenomas may increase in size and require urgent surgical decompression because of apoplexy; disc ruptures can usually be treated conservatively; head trauma should be treated in the same way as in a nonpregnant patient. This article discusses several surgical and anesthetic issues that are important in dealing with these conditions.