I am pregnant, and I have some very small cerebellar hemangioblastomas. My doctor is wondering if we should schedule a Caesarean section, to minimize straining and prevent rupture of the brain tumors. Also, is it okay to have an epidural and a relatively natural delivery? What do you think? -- Hélène P., Québec, Canada

There is no reason that you cannot have an epidural, and there is no need to schedule a Caesarean Section if you have small, quiescent brain tumors. However, if the tumors are large, or have a cyst, and are exerting intracranial pressure, then it would be best if the labor and delivery were as short as possible, and a Caesarean would be indicated.

As you undoubtedly know, during pregnancy tumors may grow or a cyst may appear. We do not know whether this is in fact caused by the pregnancy, or would have occurred even if you were not pregnant, but certainly the disease does not stop during pregnancy. It will be up to your neurosurgeon to evaluate the situation with an MRI and clinical examination and make the best recommendation in your situation.

See also Grimbert, Richard, et al., "Pregnancy in VHL disease." Am. J. Obstet. Gynecol. 1998

- Stéphane Richard, M.D., Président of the VHL Study Group, Hôpital de Bicêtre

As printed in the VHL Family Forum 7:1, March 1999. For permission to reprint, please contact VHL Family Alliance, info@vhl.org. Further information is available from the VHL Family Alliance, info@vhl.org.

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