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Case Study: Removing Pregnant Patient’s Glioma to Support Safe Childbirth

A team approach from the USC Brain Tumor Center and maternal-fetal teams at Keck Medicine of USC helped a mother beat cancer and deliver without complications.

Shortly into her second trimester of a healthy pregnancy, a 34-year-old patient began experiencing strange symptoms. Her limbs were twitching, and her head was turning side to side on its own. 

By week 20, the patient had developed foot drop, a condition always caused by a neurological problem. She was soon referred to a neurologist, who scheduled an MRI.

The patient and her husband received frightening news: There was a mass growing in her brain. And because the contrast dye used during MRIs can’t safely be administered to pregnant women, doctors weren’t able to specifically diagnose it.

Collaborative Care Finds Answers

Soon after the diagnosis, a family friend recommended the patient meet with Arthur Toga, PhD, director of the USC Institute of Neuroimaging and Informatics.

Toga, who is also the director of the Keck School of Medicine of USC’s Laboratory of Neuroimaging, put in a referral to neurosurgeon Gabriel Zada, MD, director of the USC Brain Tumor Center — a multi-disciplinary team created to expediate care for patients who encounter life-threatening diseases — at Keck Medicine of USC.

By the time the patient met with Zada, he had already reviewed her MRI. But he was also unable to give her a specific diagnosis from the undetailed image.

Zada took her back to Toga, who had a state-of-the-art MRI machine in his lab. It produced a clearer image, revealing that the mass was either a meningioma, a noncancerous tumor, or a cancerous glioma.

It would take a craniotomy to remove the tumor to determine its nature.

Swift, Lifesaving Action

A glioma is a rare and aggressive tumor of the central nervous system that starts in the brain. The exact cause of gliomas is unknown, but studies have shown that genetics and female hormonal fluctuations can increase one’s risk.

"Gliomas wind their way through the healthy brain,” says Frances Chow, MD, a neuro-oncologist at the Brain Tumor Center and an assistant professor of clinical neurological surgery and neurology at the Keck School of Medicine of USC. “If there is any delay in treatment, the tumor can spread with deadly speed.”

The possibility of an aggressive cancer compelled Zada to operate under challenging circumstances.

“It's very hard to operate on pregnant women for brain tumors because you have to consider not only the fetus, but the mom,” Zada says. “Usually, we try to leave the baby in there for as long as possible for the baby's health. But Melody was getting worse.”

To help ensure the safety of mother and baby, Zada brought in Marc Incerpi, MD, a high-risk maternal-fetal specialist to consult on the surgery, which would take place at USC Norris Cancer Hospital, part of Keck Medicine of USC.

Successful Surgery, New Hurdles

The patient’s tumor came within a millimeter of her motor fibers, making the surgery extremely delicate.

“Any damage to those and she could have had permanent paralysis,” Zada says. “These surgeries are like walking on a high wire — there's not a lot of room for error.”

The patient spent the next three days in the intensive care unit at Keck Hospital of USC, then was sent home to continue her recovery.

Soon after, doctors determined that the tumor was a glioma, which meant that the patient required immediate chemotherapy. But doctors couldn’t begin treating the cancer until the baby was born. The neurology team would have to work with experts from OB/GYN and maternal-fetal medicine to confirm a suitable date to induce labor.

"While we prefer to perform preterm births closer to 32 to 34 weeks of gestation, we had to think outside of the box in this case,” Incerpi says.

Babies born before week 28 are considered extremely premature, and they face a much higher risk of lung failure, brain damage, long-term health problems and disabilities.

The mother’s life was also at risk. Ultimately, Laila Al-Marayati, MD, the OB/GYN who would perform the delivery, decided with Zada and Incerpi to deliver the patient’s baby at the 27th week of pregnancy.

Healthy Mother and Baby

To help the baby’s lungs develop as quickly as possible, the patient received a series of steroid shots timed 24 hours apart. Then, her care team administered magnesium infusions to protect the baby’s brain.

A Caesarian section would be necessary due to the baby being in a breech position, but he was born breathing on his own — an extremely rare occurrence among extremely premature deliveries.

The baby was in the neonatal intensive care unit for 57 days. While he needed oxygen support, intubation was never required.

The child, now a toddler, is in excellent health, and the patient has “recovered tremendously well,” Chow says.

People who have recovered from brain cancer are never considered in remission, but Chow confirmed that there is currently no evidence of the disease in her patient.