### Preconception Considerations in Neurosurgery In neurosurgery, preconception care is critical for women with pre-existing neurological conditions or those who have undergone neurosurgical procedures. The goal is to optimize maternal and fetal outcomes by managing neurological conditions before pregnancy.

#### Key Preconception Considerations in Neurosurgery:

1. Epilepsy and Seizure Disorders

1. Ensure seizure control before pregnancy.
2. Adjust antiepileptic drugs (AEDs) to minimize teratogenic risks (e.g., valproate is associated with neural tube defects).
3. Monitor drug levels, as pregnancy can alter AED metabolism.
4. Consider folic acid supplementation (≥4 mg/day) due to increased risk of neural tube defects.

2. Hydrocephalus and Shunted Patients

1. Evaluate ventriculoperitoneal (VP) shunts for functionality before pregnancy.
2. Be aware that increased intra-abdominal pressure during pregnancy may affect shunt function.
3. Consider alternative CSF diversion strategies if necessary.

3. Brain and Spinal Tumors

1. Assess tumor status and potential pregnancy-related growth stimulation (e.g., meningiomas can grow due to hormonal influence).
2. Delay pregnancy if surgical intervention or adjuvant therapy (radiotherapy, chemotherapy) is needed.
3. Consider MRI monitoring during pregnancy (preferably without contrast).

4. Spinal Disorders and Previous Spinal Surgery

1. Women with prior spinal fusions or instrumentation should be evaluated for potential pelvic and lumbar spine stress during pregnancy.
2. Assess risks for worsening spinal stenosis or herniation due to increased lumbar lordosis.
3. Consult anesthesia for epidural feasibility if prior spinal surgery exists.

5. Stroke and Cerebrovascular Conditions

1. Arteriovenous malformations (AVMs) and intracranial aneurysms require preconception risk assessment due to increased rupture risk during pregnancy.
2. Carotid or vertebral artery dissections require control of hypertension and anticoagulation planning.
3. Pregnancy-related hypercoagulability increases stroke risk in certain conditions.

6. Chiari Malformation and Syringomyelia

1. Evaluate for worsening symptoms (headache, myelopathy) with increased intracranial pressure (ICP) due to pregnancy-related fluid shifts.
2. Discuss vaginal vs. cesarean delivery based on neurological status.

7. Multiple Sclerosis and Neuroimmunological Disorders

1. Consider disease-modifying therapy (DMT) adjustments, as some are teratogenic.
2. Pregnancy often reduces MS relapse rates, but postpartum relapse risk increases.
3. Evaluate neurosurgical implications if there is severe disability.

8. Neurosurgical Medications and Pregnancy

1. Avoid teratogenic drugs such as valproate, methotrexate, and certain immunosuppressants.
2. Adjust corticosteroid use if needed for neurological inflammation.
3. Consider thromboprophylaxis in patients at high risk of venous thromboembolism (VTE) due to immobilization.

### Conclusion Women with neurological conditions planning pregnancy should undergo preconception counseling with a multidisciplinary team, including a neurosurgeon, neurologist, obstetrician, and anesthesiologist. Optimizing neurological health before conception improves both maternal and fetal outcomes.

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