Pregnancy is usually a time filled with happiness and hope, plans for the new addition to the family, and pampering. But for some expecting moms, that journey can be jolted by an unexpected and very rare diagnosis — one of a brain tumour.

Pregnancy already brings significant physical changes, emotional ups and downs, and constant monitoring of health. The presence of a brain tumour during this time turns the situation into one of the most complex medical scenarios a person can face. In such cases, two lives are at stake, and every decision must be made with caution, deliberation, and careful consideration.

Diagnosis and Initial Assessment

Identifying a brain tumour diagnosis in a pregnant woman is particularly challenging because many of the symptoms of brain tumours usually share common physiological changes and discomforts associated with pregnancy. Nausea, vomiting, persistent headaches, and dizziness are common during pregnancy, but they are also key warning signals of a brain tumour.

This overlap often leads to misdiagnosis or delay in diagnosis, as medical professionals may initially attribute the symptoms as pregnancy-related discomfort. When these symptoms persist or worsen, imaging is used to confirm the diagnosis.

Magnetic Resonance Imaging (MRI)is the preferred method, as it provides detailed images without radiation and is considered safe during pregnancy. In some cases, additional tests or a biopsy may be required if the type of tumour is unclear.

Computed Tomography (CT) scans are generally avoided during pregnancy as they use ionising radiation, which is a risk to the foetus.

Diagnosis of brain tumours during pregnancy is typically established through a multidisciplinary approach involving obstetricians, neurologists, and radiologists. Once the type of tumour is confirmed, the medical team considers several key questions:

1. Is it a low-grade or a high-grade tumour?
2.  Is it causing pressure on the brain?
3.  How far along is the pregnancy?

Tumours that are slow growing, such as meningiomas, may be monitored closely until it is safe to give treatment (particularly either in the second trimester or after delivery). More aggressive tumours like glioblastomas may require immediate action, even in early pregnancy.

Impact of Pregnancy on Tumours

Pregnancy causes major physiological changes in a woman, including increased levels of hormones like oestrogen and a rise in blood volume. These changes can, in some cases, accelerate the growth of the tumour.

Treatment Considerations

Treatment of brain tumours in pregnancy requires a multidisciplinary approach that carefully considers the safety and health of both the mother and the foetus. Treatment plans are highly individualised and depend on several factors, including the type and location of the tumour, its rate of growth, the patient’s symptoms, and the stage of pregnancy.

Surgery is often recommended if the tumour is causing increasing intracranial pressure, bleeding, or severe symptoms. The second trimester is considered to be the safest period for a surgery, as the risk to the foetus is lower than in the first trimester and the uterus is not yet large enough to complicate things.

If the patient is in the third trimester, doctors may consider scheduling an early delivery (typically between 32 to 36 weeks) so that surgery or additional treatment can begin promptly afterward.

Chemotherapy and radiation therapy are typically delayed until after delivery unless the situation is urgent. Some chemotherapy agents may be used during the second or third trimester with caution, but they are usually avoided in the first trimester due to the high risk of birth defects.

Delivery Considerations

Delivery planning in this context involves careful coordination among obstetricians, neurosurgeons, and anaesthesiologists. When and how to schedule the delivery depends on several factors:

Timing

• If the tumour is stable and not causing significant symptoms, delivery may proceed at full term (around 39 to 40 weeks).
• If the tumour is aggressive or the mother’s condition is worsening, an early delivery (32 to 36 weeks) may be recommended to allow prompt treatment.
• In the case of a medical emergency, such as seizures or brain swelling, an emergency delivery may be performed at any gestational age to protect the mother’s life.

Mode of delivery

• If the tumour affects the mother’s ability to safely go through labour—for example, due to increased intracranial pressure—then a C-section is usually recommended to minimise the risk of complications during delivery.
• If the tumour is small and not causing pressure-related symptoms, vaginal delivery may still be an option.

Psychological considerations

A brain tumour diagnosis is inherently a life-changing and traumatic event. When it occurs during pregnancy, it introduces an additional layer of emotional and psychological distress. This can impact the overall well-being of the patient.

Patients commonly experience:

• Heightened anxiety
• Depression
• Guilt or fear about the baby’s future
• Emotional isolation

Recognising and addressing these emotional needs is essential. Mental health support—through counselling, support groups, or psychiatric care—should be an integral part of treatment.

Conclusion

A brain tumour diagnosis during pregnancy presents one of the most complex, rare, and emotionally challenging medical scenarios. It requires highly individualised care, constant re-evaluation, and a coordinated effort across multiple specialities.

With thoughtful planning and compassionate support, it is possible to protect the health of both the mother and the baby. The path may be difficult, but patients do not have to face it alone; with the right care, there is hope for a safe outcome.

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Brain tumours, though commonly feared as cancerous, are not always malignant. They are broadly classified into malignant (cancerous) and benign (non-cancerous) tumours. While malignant tumours grow aggressively and can spread to surrounding tissues, benign tumours grow slowly and do not spread, but can still cause significant problems depending on their size and location within the brain. Regardless of type, both require medical attention due to the critical functions governed by different parts of the brain.

Early detection plays a vital role in improving outcomes, minimising complications, and enabling timely treatment. Symptoms often vary based on the tumour’s size, type, and specific location in the brain, but certain signs should prompt a medical consultation.

One of the most common early symptoms is a persistent headache, which may worsen over time and is often more intense in the early morning or when lying down. These headaches are usually different from typical tension headaches and may be associated with nausea or vomiting that has no obvious cause.

Visual disturbances such as blurred or double vision, partial vision loss, or abnormal eye movements can signal pressure on the optic nerves. Similarly, hearing issues or ringing in the ears may occur if the tumour affects auditory pathways.

Cognitive or personality changes such as confusion, memory problems, mood swings, or difficulty concentrating are important early indicators, especially when they are new or progressively worsening. In children, such changes may show up as poor school performance or developmental regression.

Seizures in someone with no previous history of epilepsy should always be investigated, as they can be the first noticeable symptom of a brain tumour. Other neurological signs like numbness, weakness, or lack of coordination, especially on one side of the body, are also concerning.

Speech difficulties, such as trouble understanding or forming words, and imbalance or dizziness, especially when walking, may suggest tumour involvement in language or motor control areas of the brain.

It’s important to note that these symptoms can overlap with more common, less serious conditions. However, if they are persistent, progressive, or unexplained, it is crucial to consult a neurologist. Brain imaging, like MRI or CT scans, can help confirm the diagnosis early.

Raising awareness about these warning signs empowers patients and families to seek help sooner. Whether benign or malignant, early detection of brain tumours significantly improves the chances of effective treatment and a better quality of life.

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PUNE: A 57-year-old female patient, who had been experiencing severe headaches and difficulty walking, has made a remarkable recovery after undergoing a complex neurosurgical procedure at Sahyadri Super Speciality Hospital, Hadapsar. The patient, who had visited multiple hospitals in the city before coming to Sahyadri, was diagnosed with multiple meningiomas located at the craniovertebral junction, a rare condition where two or more nonmalignant brain tumors develop in different areas of the brain, occurring in only 1%–10% of cases.

Dr. Siraj Basade, Senior Neurosurgeon at Sahyadri Super Speciality Hospital, Hadapsar led the delicate and highly complex surgery that resulted in a complete tumor excision. The procedure was guided by the latest intra-operative neuro-monitoring and ultrasound technology, which played a crucial role in ensuring the safe and successful removal of the tumor.

The patient initially came to the hospital with symptoms of raised intracranial pressure (increased pressure in the brain), along with weakness in her arms and stiffness in her legs, which made walking difficult. An MRI scan showed that the largest tumor was pressing against the cerebellopontine angle and displacing key structures like the vertebral artery and the spinal cord. This was also blocking the flow of fluid in her brain, leading to her severe headaches.

“This advanced technology allowed us to safely navigate around critical parts of the brain and successfully remove the tumor without causing damage,” explained Dr. Siraj Basade. “The use of intra-operative neuro-monitoring and ultrasound was key to ensuring the patient’s safety during such a delicate procedure.”

To relieve the pressure, doctors first performed a procedure called a VP (ventriculoperitoneal) shunt to drain the excess fluid from her brain, which immediately reduced her headaches. Once stabilized, the patient underwent a more complex surgery, called a posterior fossa craniotomy, where the skull was opened at the back of the head to access and remove the tumors. The surgery was guided by special monitoring equipment to ensure the procedure was safe and successful.

Post-surgery, the patient experienced a dramatic improvement in her condition. She regained her ability to walk normally and muscle strength with the help of physiotherapy and has made a full recovery. This case represents one of the rarest occurrences, as only one in lakhs of brain tumor patients present with such a unique condition involving the brainstem.

Dr. Basade emphasized the importance of the advanced surgical techniques used in this case, “This patient had a very rare and complex tumor, and without the use of intra-operative neuro-monitoring and ultrasound, the surgery could have posed significant risks. The technology allowed us to navigate around critical structures, such as the vertebral artery and cervical cord, to ensure a safe and complete tumor removal.”

The patient and her family expressed their gratitude to the medical team at Sahyadri Super Speciality Hospital for the expert care they received. “We had visited several hospitals in Pune, but it was here at Sahyadri that we found hope. We are forever grateful to Dr. Basade and Sahyadri team for giving us our life back,” said the patient’s family.

This case underscores Sahyadri Hospital’s commitment to utilizing cutting-edge technology to provide the highest quality of care to patients, particularly in such complex neurosurgical cases.

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The Oncosurgery Mastercourse has evolved into a significant educational event for the surgical community, offering participants a unique opportunity to interact with field experts and learn from their extensive experiences. This time, led ably by the organizing chairman Dr. Dushyant Mandlik, and the tireless team of senior head and neck cancer surgeons at HCG Aastha Cancer Centre, Ahmedabad—Dr. Aditya Joshipura (Organizing Secretary, OM 9.0), Dr. Purvi Patel, Dr. Parin Patel, and Dr. Nitin Sharma—OM 9.0 delved deep into a topic that has traditionally been considered an Achilles’ heel for many clinicians across the country. A few notable topics covered during the master course included the retrograde approach for parotidectomy, modern approaches to facial reanimation and reconstructing facial arches after injury to the facial nerve, and the use of intraoperative neuromonitoring systems for better results in complicated scenarios.

The masterclass was attended by 125 healthcare professionals, including Dr. Anil D’Cruz (Former UICC Chief), Dr. Jyoti Dabholkar (Chairman of the Governing Council of the Federation of Head Neck Oncology), and Dr. Arvind Krishnamurthy (Professor of Surgical Oncology at Adyar, Chennai), along with 25 distinguished national faculty members. The event also featured a guest online lecture by Professor Joseph Dayan, a leading surgeon from MSKCC Hospital, New York

Dr. Kaustubh Patel, Course Director for OM 9.0 and a Director – HCG Aastha Cancer Centre, Ahmedabad, expressed his enthusiasm, stating, “It gives us immense pleasure to welcome one and all for the 9th edition of the Oncosurgery Mastercourse, dedicated to salivary gland tumors. It requires thorough knowledge and continuous upgradation of skills to handle complex cases in this area. Over the years, this event has become a beacon of excellence. With the resounding success of OM 9.0, HCG Aastha Cancer Centre Ahmedabad reaffirms its commitment to comprehensive care and enhancing patient outcomes.”

Dr. Daxesh Patel, Course Director for OM 9.0 and Senior Consultant – Head and Neck Surgical Oncology, HCG Aastha Cancer Centre, Ahmedabad, remarked, “The 9th edition of OM was an outstanding academic triumph, uniting experts and participants in a dynamic exchange of knowledge and experiences. Continuous collaborative efforts and multi-modality treatments are the need of the hour. The diversity of perspectives and innovative approaches shared during the event has been a step in the right direction. We are hopeful that the young surgeons attending this event will go back enriched with better skills.”

HCG Aastha Cancer Centre Ahmedabad continues to lead the way in innovative cancer treatment and education with its team of outstanding doctors, ensuring that medical professionals nationally and internationally are equipped with the best arsenal to provide quality care for their patients. The 9th edition of the Oncosurgery Mastercourse stands as an indication of this untiring dedication.

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Honoring the event with their esteemed presence were Dr. Yashraj Patil, Trustee & Treasurer; Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune; Dr. J.S. Bhawalkar, Dean, Dr. D. Y Patil Medical College, Hospital and Research Centre, Pune; Dr. H.H. Chavan, Medical Superintendent, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune; and Dr. Manisha Karmarkar, CEO, DPU Super Specialty Hospital, Pimpri, Pune. Senior medical experts of the hospital including Dr. Rahul Kendre, Lung Transplant Physician and Interventional Pulmonologist; Dr. Sameer Chauhan, Minimally Invasive & Robotic Surgeon, who will be leading the unit under the tutelage of Dr. Anurag Garg, HOD, Cardiothoracic Surgery. Also present were other dignitaries from the senior management of DPU Super Specialty Hospital, Pimpri, Pune to commemorate the occasion.

This newly launched Centre of Excellence will primarily offer minimally invasive thoracic surgeries including Video-Assisted Thoracic Surgeries (VATS) and Robotic-Assisted Thoracic Surgeries (RATS) for several complexities including lung tumors, tumors in the chest wall, anterior and posterior mediastinal tumors, and bullous disease of lungs and thymoma.

The commencement of this unit is in response to the need for a state-of-the-art dedicated robotic thoracic surgery department as there are just a handful of centers equipped to perform this nature of surgery across the state and country at large. This Centre of Excellence launched at DPU Super Specialty Hospital, Pimpri, Pune, is backed by a world-class robotic system – 4th Generation Da Vinci Xi, which will be used to perform the surgeries and is the most revered and established surgical robotic system across the globe with a proven track record. 

The launch of this dedicated department of robotic thoracic surgery will benefit the patients of Pune and neighborhood cities like Satara, Sangli, Kolhapur, and Nashik as they will be able to access this world-class treatment facility without having to travel to distant cities or states. The OPD for consultation will be hosted from Monday to Friday at DPU Super Specialty Hospital, Pimpri, Pune and patients will be attended to on an appointment basis to enable a seamless experience.

Commenting on the launch, Dr. P.D. Patil, Chancellor, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, said, “We aim to establish Pune as a leading destination for healthcare tourism by creating an all-inclusive healthcare infrastructure for the benefit of our citizens. This landmark development is a significant move that honors this commitment and addresses the demand for a state-of-the-art robotic thoracic surgery department, benefiting Pune and neighboring cities. Going forward, we are dedicated to continually upgrading and strengthening our infrastructure with cutting-edge technology in the best interest of our city and people.”

Dr. Bhagyashree Patil, Pro-Chancellor, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, commented “We as a leading healthcare institute are driven to be on our front foot when it comes to enabling a robust infrastructure and world-class treatment facilities in the best interest of our citizens. The launch of this new Centre of Excellence about Robotic Thoracic Surgeries is a strong testament to our commitment and we are overjoyed to bring this one-of-a-kind world-class procedure to the people of Pune and Maharashtra at large.”

Dr. Yashraj Patil, Trustee & Treasurer, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, commented “The launch of a dedicated department for robotic thoracic surgery was the need of the hour and we are proud to pioneer another major landmark in the history of Pune’s medical landscape. Being a leader in healthcare, we strive to go a notch higher when it comes to building a holistic medical infrastructure and promoting patient-centricity across levels. This move reflects our commitment to the same.”

Dr. Manisha Karmarkar, CEO, of DPU Super Specialty Hospital, Pimpri, Pune, stated “As the pioneers to bring the world’s best robotic surgical system to Pune, we are excited to add another feather of remarkable achievement to our hat with this launch. Our focus remains persistent on providing the most advanced and quality healthcare amenities with patient-centricity as the core belief.”

Dr. Aneez D.B. Ahmed, Director of Robotic Thoracic Surgery, said “This innovative Robotic Thoracic Surgery Department offers numerous advantages, such as performing highly intricate surgeries through smaller incisions and providing a 3D magnified view for better pathology localization, thus enhancing precision and efficiency as compared to traditional methods. Going forward, our vision is to start a dedicated cardiothoracic robotic surgery program.”

Dr. Sameer Chauhan, Minimally Invasive & Robotic Surgeon, DPU Super Specialty Hospital, Pimpri, Pune, stated, “This move will provide ample benefits to patients, right from reduced need for blood transfusions, minimal complications resulting in faster recovery times, allowing them to resume normal activities sooner. We extend our sincere thanks to the leadership of DPU Super Specialty Hospital, Pimpri, Pune, for empowering us with this first-of-its-kind department in Pune, which will help deliver significant benefits to patients in need.”

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BENGALURU: In a ground-breaking surgical achievement, a 67-year-old woman from Bangalore has successfully undergone an innovative and pioneering procedure to remove a tumor from her skull base through her mouth. Mangala (name changed) was presented with a 2×2 cm tumor behind her upper jaw. What made the procedure unique was the location which was a challenging one; it was behind the upper jaw in the parapharyngeal space, a narrow corridor that extends from the upper neck to the skull base. It was in proximity (around 1.2 cm) to the internal carotid artery, the main artery that supplies blood to the brain, as well as multiple cranial nerves that control tongue movement, voice, and shoulder function.

Conventional approaches would involve splitting the lower jawbone or creating a controlled fracture of the upper jawbone to move it out of the way for access. The concern with endoscopic removal was that it would require removal in pieces and not whole, leading to spillage and a higher chance of recurrence. Robotic surgery was also not considered as conventional robotic surgery does not involve drilling away from the bone, which was required to provide access in this case. To reduce the trauma associated with surgery and recovery, the team of expert doctors at SPARSH Hospital used a novel approach, where the entire approach was through the mouth, and the access was by removing the posterior aspect of the upper jaw bone and displacing the muscles to create a corridor to completely remove the tumor.

Speaking on the success of this innovative surgery, Dr. Narayana Subramaniam, Director – Head & Neck Surgery, Oncology, and Director – Clinical Innovation, at SPARSH Hospital, Bangalore says, “This was a novel approach for a novel tumor. By devising this approach, we were able to access this tumor and remove it completely without splitting the upper or lower jaw and avoiding any incisions on the face. She also had a smooth recovery with no weakness of any major cranial nerves or intra-operative bleeding, which is common with conventional approaches. Complex head and neck surgery requires a patient-centric approach, extensive expertise, and lots of teamwork, which enables excellent outcomes.“

In this remarkable surgical accomplishment, the two-and-a-half-hour procedure ended in a smooth recovery for Mangala. SPARSH Hospital takes pride in this exceptional surgical achievement, showcasing its commitment to innovative and patient-centric care. This phenomenal success highlights the dedication to advancing healthcare through progressive solutions for patients dealing with complicated medical challenges. 

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Karkinos Healthcare is a purpose-driven, technology-led oncology platform, focused on early detection, advanced diagnostics, and treatment delivery of common cancers, using its Distributed Cancer Care Network across India. Karkinos Healthcare provides end-to-end solutions for the oncology ecosystem, including disease screening, diagnosis, surgery, chemotherapy, radiotherapy, and comprehensive patient navigation through the care continuum, in addition to operating advanced research and development laboratories. The company is on a mission to create ‘Community as a Cancer Centre’ with an endeavor to serve one million patients annually by addressing the accessibility and affordability gaps in cancer care through a digitally curated hub and spoke and further spoke model, and not restrict cancer care to comprehensive centers alone.

“It is our continued goal to improve health outcomes for patients globally by expanding access to precision oncology and equipping local health institutions with the tools and technology needed to practice data-driven medicine,” said Dr. Jurgi Camblong, CEO and Co-founder, SOPHiA GENETICS. “By aligning with Karkinos, who share the mutual goal, we can help increase the use of best-in-class cancer testing for rural and underserved communities around the world.”

On this strategic partnership, Dr. R Venkataramanan, Founder and CEO, of Karkinos Healthcare said, “Through collaborative research initiatives, Karkinos Healthcare aims to address the comprehensive genomic landscape identification for the Indian population, with a focus on precision medicine. This alliance will have the potential to generate evidence and world-class research for faster and accurate diagnosis and better control and management of cancers, particularly for the underprivileged population of our country.”

The SOPHiA DDM Platform is designed to compute a wide array of genomic variants and continually hone machine learning algorithms to detect rare and challenging cases. Karkinos Healthcare will use SOPHiA GENETICS’ technology to expand its offerings, advance research, and streamline workflow for a variety of blood cancers, including Myeloid cancer and Lymphoma. In addition, the company will analyze solid tumors for a variety of cancer types including ovarian, prostate, breast, pancreas, lung, colorectal, skin, and brain cancers.

The SOPHiA DDM Platform offers tailored NGS-based workflows to streamline processes – from sample to report – to accelerate analysis. By using the SOPHiA DDM Platform, researchers from Karkinos Healthcare will quickly obtain high-quality and reproducible data that will ultimately accelerate clinical research studies and advance the use of precision medicine.

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While it is true that headaches are one of the most common symptoms associated with brain cancer, they are not always the first indicator. Dr. Pravin further highlights that in the case of brain tumors, headaches are often accompanied by other symptoms that may vary depending on the tumor’s location and size. If left untreated over time, these tumors can lead to severe complications such as permanent neurological damage including difficulty with speech and memory problems.

Common symptoms include headaches, seizures, visual disturbances such as blurred vision or double vision as well as speech difficulties and loss of coordination. In case the person experiences persistent headaches or any other unusual symptoms such as seizures or changes in vision, it’s essential to seek medical attention immediately. Early detection is crucial when dealing with brain tumors since early treatment increases your chances of successful recovery.

In some cases, brain tumors can also cause hormonal imbalances leading to weight gain/loss and changes in menstrual cycles for women. It’s important to note that these symptoms are not exclusive to brain tumors but could be caused by other medical conditions as well.

Dr. Pravin also says that if a person is experiencing any persistent symptoms in daily life, there is an urgent need to seek advice from the doctor who may refer for further investigations such as MRI scans. Early detection ensures better treatment outcomes.

Treatment for a brain tumor may involve surgery if it is accessible; chemotherapy to kill cancer cells through medication; radiation therapy that uses high-energy rays to destroy cancer cells; targeted drug treatment among others.

Photo by Matteo Vistocco on Unsplash

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