Meningioma

Who can get meningioma?

Both females and males can have meningioma from 30 years of age until the ages of seniority.

How does meningioma develop?

Meningioma is a situation which the cells of the outmost membrane covering the brain start growing in an uncontrolled way and create a mass. This membrane covering the brain and the cerebellum creates a mass in the indents in skull base, in the bases of anterior, middle and posterior fossa and in the longitudinal fissure that divides left – right hemispheres of the brain. These masses are mostly benign, and can result in a happy ending if their location allows for easy removal. Ten percent of these mass are malign. Rarely, they may develop in the ventricles in brain without being adjacent to any brain membrane.

What are the symptoms of meningioma?

It may not produce any symptoms before it reaches a particular size. If it pushes against key functioning structures, relevant symptoms emerge. For instance, meningioma that develops adjacent to – and pushes against- optic nerve (parasellar) causes partial or complete loss of vision. If it develops over olfactory nerve, it causes loss of sense of smell. If the mass grows here large enough, it causes changes in personality and mood, the frontal syndrome. When meningioma develops adjacent to key functioning regions of brain, it poses serious risks. Damages on brain stem and cranial nerves are frequent. Loss of hearing, difficulty in swallowing, weakness in strength, difficulty with balance etc. are also observed frequently.

When meningioma becomes large enough to increase the intracranial pressure in relatively silent regions of brain, it may cause complaints such as headache, nausea, vomitting. Some meningioma may lead to thickening of the adjacent bone structure and swelling, which may be visible from outside (sphenoid wing), and it may also cause bulging of the eyes (eye socket meningioma).

What treatment method does Dr.Yunus AYDIN apply?

Not all meningioma that appear on the brain MR requires surgery. Those adjacent to delicate regions of brain may need to undergo surgery earlier, regardless of their size, whereas those located in silent brain should not undergo an operation -unless the meningioma increases the intracranial pressure- but should be monitored on a yearly basis. Silent brain meningioma with slowly growing curves should be subjected to monitoring only unless they present symptoms of pressure, particularly in old age people.

For the treatment, the location of tumor matters more than its size in making the decision of surgery. The tumors adjacent to the sinuses, which are venous system of brain (such as parasagittal, middle fossa and posterior fossa), must be removed even if those are small in size. When they grow further and occupy the sinus, they may not be removed completely or surgery becomes more risky. Those adjacent to the arteries that feed brain (such as inner part of the sphenoid wing) must be removed before they grow large enough to cover the blood vessels. There is not a standard treatment plan that applies to every patient. Treatment options are decided after a patient-specific assessment is made, also considering the experience of the surgeon, the number of types of surgeries he has performed, the age of patient, the location of tumor.

The ideal treatment would be to remove the tumor completely including the membrane on which the tumor has developed. If the location of tumor does not allow for removal, surgeons remove as much of the meningioma as possible. The amount of tumor to be removed must be limited to the experience of surgeon and must not pose a higher risk for the patient. Surgeon may take some risk in favour of the patient based on his experience. In today’s condition, the patients and their relatives should be informed about those risks while “the informed consent” is filled in.

What are the alternative treatment methods for meningioma?

Gamma ray is the most common option for the patients who have tumors at locations which put surgery at risk, for those who have a bad overall health and are not good candidates for surgery, and for the cases in which tumors were not removed completely. Unfortunately, medication has not yet been an option in these cases.

Some surgeons prefer a method at the pre-surgery stage in which the blood vessels that feed the tumor are filled with substances like synthetic glue in order to have less bleeding during the surgery (I do not use that method). This method, if the case allows for it, can be used to block the relevant blood vessels and delay the growth of tumor.

What if meningioma is not treated?

The tumors, which are not adjacent to the delicate regions of brain and are smaller than the medium size tumors, and are growing slowly, do not produce any problem during the entire lifetime. These tumors do not require a treatment.

Those which grow large enough to increase the cranial pressure will kill the patient, if not removed.

Those which are located adjacent to delicate regions of brain will cause permanent damage, if not removed (loss of vision, loss of hearing, weakness, difficulty with balance, diplopia, etc.)

Post-op course in meningioma

There is a direct relation between the location of tumor and the post-op period. For the simple ones, patients may leave for home 2-3 days after surgery. As for the surgeries on the locations like brain stem, cerebellopontine angle (CPA), clivus, inner part of sphenoid, tuberculum sellae, the course would be the same as those of the simple ones, if there has been no damage on blood vessels and nerves. Those who have had such damages might need intensive care and rehabilitation processes.