Pregnant, with a meningioma brain tumour
Posted on 12 March 2020
Pregnant with her first child Masechaba had a brain tumour but she didn’t know it yet.
I was six or seven months pregnant, and everything was pretty normal,” says Masechaba Mfeka-Hausen, “until I lost the brightness in my eyesight.” Then she stopped seeing friends. Stopped leaving the house; started sleeping more. She didn’t notice. But friends and family did. To them, these were the beginning signs of what would become a dramatic and progressive change in personality. “I gave birth to Robert in November,” she says. “By that time I was having debilitating migraines every day. Painkillers had no effect. They were so bad that I was unable to spend any time with my baby. Doctors gave us all kinds of different diagnoses: some said I was depressed, others said I just needed a headache pill.”
Masechaba’s condition got much worse, in a matter of weeks, as chronic fatigue became confusion. “All I could do was sleep. At one point, someone told me it had been two weeks that I had last taken a shower. One day, my husband panicked and called ahead to the Emergency Centre at Mediclinic Panorama. I said, I’m ready, let’s go. He looked at me and said, Masechaba, you’re not wearing any pants.”
Masechaba was suffering from severe neurological deterioration. “Headaches and vomiting might seem like typical symptoms of pregnancy, but she had other warning signs as well,” explains Dr Johan Malan, the neurosurgeon who treated her at Mediclinic Panorama. “She was losing interest in things that would usually be a part of her daily routine, and by the time I saw her for the first time, her vision was so bad that she could only see shadows, outlines or hand movements.”
Just a month after giving birth, doctors at the hospital’s Emergency Centre put the pieces of the puzzle together. Signs of raised intracranial pressure, resulting in chronic migraines, coupled with drastic changes in eyesight, led them to perform a computed tomography (CT or CAT) scan of her brain. They found a tumour in the anterior cranial fossa. It was the size of a grapefruit.
In simple terms, a brain tumour is a mass of abnormal cells that collects and grows together in your brain. Because the skull is a rigid structure, this growth can cause issues, and even progressive damage to the cells in your brain matter, as it presses against parts of the brain.
Brain tumours are usually classified according to their position, size and rate of growth. When even a tiny tumour develops directly within the brain tissue, patients might show severe symptoms, while those that grow from outside can cause areas of the brain to shift.
Masechaba’s tumour is known as a meningioma, forming on the membranes, or meninges, that layer and line the brain and spinal cord just inside the skull. “The brain is an amazing organ,” says Dr Malan, “and it can be very accommodating to a new presence. But even so, there is only so much space.”
The extent of the pressure these tumours cause, and the parts of the brain they affect, can lead to varying symptoms in each case, says Dr Malan. Vomiting, dizziness, confusion and even seizures are common, as the tumour grows and puts greater pressure on the surrounding areas of the brain.
Where did it come from? Dr Malan says we may never know. “Most of the tumours we see are sporadic; they occur with no discernible cause. Even the latest literature indicates there is no reliable reason why one person will develop a meningioma and another won’t.”
Most meningiomas in the anterior cranial fossa are characterised by insidious but steady growth. “She had probably had the tumour for years before it became symptomatic. This tumour developed by only a few millimetres each year, which gave her brain time to adapt to this new presence.”
Masechaba’s meningioma may have been slow-growing at first, but it had hormonal receptors, says Dr Malan. In some cases, pregnancy can affect the behaviour of a tumour, causing it to grow rapidly. All of this makes sense to Masechaba, she explains.
The year before, she’d suffered two miscarriages. “I’d been regularly building up hormones, and they caused a kind of growth spurt in the tumour.”
This led to a swift progression of her symptoms. As it grew it pressed on the front of her brain, altering her personality and seriously affecting the functioning of her optic nerve. By the time she arrived at the EC, almost delirious, Masechaba was on the verge of irreparable brain damage.
Dr Malan had one option to save Masechaba’s life: surgically remove the entire tumour. Meningioma is the most common type of tumour treated by neurosurgeons in South Africa, estimates Dr Malan.
“These tumours are rarely small,” he says. “In most cases, when they affect the frontal part of the brain, they have been allowed to develop in size, as patients are not necessarily aware of how they are being affected. It is easy to explain nausea, for example, as a known symptom of pregnancy, or to miss subtle changes in personality.”
Masechaba’s hormonal fluctuations had caused an abnormal period of growth, resulting in a larger-than-usual tumour with worse-than-usual effects.
Operating to remove a tumour of that size is not a simple task. “It’s never nice to have a tumour, cancerous or benign. But in a way a meningioma has one benefit over the other kinds – because it presses on the brain from the outside, there is no direct destruction of the tissue. That would cause permanent harm.”
There is another benefit: the surgery itself involves working from the outside in, explains Dr Malan. “For most of the procedure, in her case, we were able to work on removing
the tumour without touching the rest of the brain tissue.”
The surgery was extensive and took about seven to eight hours to complete, he says. “There were a lot of important structures – the optic nerve, the vascular system – that had been pushed away from their normal anatomical positions by the pressure of the tumour and we had to work in a small and sensitive space to avoid and protect them.”
It was also a complete success. “Fortunately, with these tumours, once we relieve that pressure, patients usually start recovering within a few days or weeks,” he explains. “There are some lingering issues with smell and taste, due to damage to the olfactory nerves, but for the most part, the brain is able to recover amazingly quickly.”
Masechaba spent a few days being monitored in intensive care and was discharged on Christmas Day, after a week of gradual recovery in hospital.
Masechaba remembers only snippets from her months-long journey back to full health. What is crystal clear in her mind, however, is the moment she heard her doctors say, It’s a 10-centimetre tumour. She also remembers lying down immediately, and falling asleep.
“I was in and out of it for months,” she says. “Even when the doctors were giving me some pretty shocking news, I was physically there, but I wasn’t present.” In many ways Masechaba feels her body was taking care of her baby. “After giving birth to Robert, I deteriorated immediately. It’s as though my body said, Your baby is healthy, he’s safe, but you have a tumour that is trying to kill you.”
Looking back, she says her progressive migraines held her back from everyone and everything, including her newborn child. “I’ve had migraines before; these were different,” she says. “It’s as though the top of my head was on fire and it never went away. I was clutching at my dreadlocks so hard I was almost pulling them out. I was trained as a paramedic, so I’m aware of the dangers, but I was popping painkillers every few hours to deal with the pain.”
This is fundamentally out of character, she says. “Up until the moment that the tumour was removed, I was not me. I was not capable of being me. My tumour had grown so large that it had pushed my entire brain to the back of my head. In fact it would have grown bigger if there had been more space. Nothing was functioning properly. I was not myself.”
Today, Robert has a wonderful bond with his father. This is beautiful to see, Masechaba says, but there is a sadness in it too. “For the first few months of his life, I wasn’t there. His dad baths him, puts him to bed, holds his hand in the shops. I missed a few of those crucial moments. So my relationship with my son is not what you’d expect. I love him and he loves me, but he is not a mommy’s boy.”
He is a miracle, however. “With a tumour of that size in my head, I do not understand how I managed to give birth to such a healthy boy, naturally. That is amazing. And to have my life back is a gift – I was blind. I was going mad from the pain of the migraines. Without that CT scan, without that diagnosis and this surgery, I would not be here, to watch him grow up. I would not be me. I would not be alive.”
She will need to go for follow-up examinations to check for signs that the tumour may grow back. Dr Malan says they were able to remove all signs of the tumour that they were able to locate on a macroscopic level, but the risk of recurrence will need to be monitored for the next ten years.
Masechaba says her family recognised her the moment she came round after surgery. “They say they saw the old me, right away. They saw a light in my eyes again. I was chatty, they say, and sassy again. That’s who I was before the tumour. And it’s who I am now. I am me again.”
ARE YOU AT RISK?
Known risk factors for meningioma include:
- Radiation treatment
- Female hormones
- An inherited nervous system disorder
SYMPTOMS OF A BRAIN TUMOUR
- Personality or memory changes
- Nausea or vomiting
- Sleep problems
- Memory problems
Read more: What happened next: Brain Tumour