What Are Meningioma Brain Tumors?
A Meningioma is a type of tumor that grows from the protective membranes, called Meninges, which surround the brain and spinal cord. Most Meningiomas are benign (not cancerous) and slow growing; however, some can be malignant. Symptoms typically appear gradually and vary depending on the location and brain area affected. Because these are slow growing tumors, not all Meningiomas need to be treated immediately.
There are a variety of treatment options for Meningiomas. The treatment that is right for you will depend on your age, general health status, and the location, size, and grade of the meningioma. Each treatment has benefits, risks and side effects that should be discussed and understood.
Surgical removal is the most common treatment for Meningiomas causing symptoms;
A neurosurgeon performs a craniotomy to open the skull and remove the tumor. A biopsy of tissue is examined by a pathologist to determine the tumor grade. Although total removal can provide a cure for meningiomas, total resection is not always possible. The tumor location determines how much can be safely removed. If the tumor cannot be completely removed, the remainder of the tumor can be treated with radiation.
Neurosurgeons and ear, nose and throat surgeons (Otolaryngologists) combine to remove these tumors by approaching them through the nose or the roof of the mouth. Endoscopic surgery is performed through the nose to remove tumors from the pituitary gland and deep areas of the skull base. This minimally invasive surgery uses a small incision at the back of the nasal cavity. Tumor removal often reverses vision problems and restores hormone balance.
Improvements in surgical techniques, particularly image-guided stereotaxy, intraoperative MRI/CT, and functional brain mapping have improved the surgeon’s ability to precisely locate the tumor, define the tumor’s borders, avoid injury to vital brain areas, and confirm the amount of tumor removal while in the operating room.
No surgery is without risk. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. Specific complications related to a craniotomy may include stroke, seizures, venous sinus occlusion, swelling of the brain, and CSF leakage.
Risks related to surgery may include:
Facial weakness is the loss of muscle control on one side of the face caused by nerve swelling or damage; it may be temporary or permanent. Temporary facial paralysis or weakness is common after surgery and may persist for 6 to 12 months. Those with facial weakness will need to take extra care of their eye with artificial tears and lubricant until facial nerve function improves. Facial nerve function is directly related to the size of the tumor.
Eye problems may occur as the result of facial weakness or paralysis that prevents the eye from closing completely. This allows the eye to become dry and unprotected. Artificial tears, eye lubricants, protective glasses, bandage contact lenses, and taping the eye shut are all options to protect the cornea.
Hearing loss is the most common complication and may be permanent in the affected ear because the tumor is wrapped around the cochlear nerve. In small tumors it is possible to save hearing when removing the tumor. Larger tumors usually have already caused some hearing loss or deafness prior to surgery.
Balance problems are common and generally improve after surgery with head exercises, Pilates, or Tai Chi. Care should be taken when using stairs or escalators. Persistent balance or dizziness problems may need treatment with vestibular (balance) rehabilitation.
Cerebrospinal fluid (CSF) leakage is the escape of CSF that flows around the brain.
Headache is common after acoustic neuroma surgery and usually subsides within several weeks. Persistent headache (>3 months) can occur after suboccipital craniotomy.
RECOVERY
The location of the tumor is the most important factor in determining the outcome. Convexity, parasagittal and lateral sphenoid wing meningiomas usually are completely removable and surgery can yield excellent results. Optic, cavernous sinus, and skull base meningiomas have a higher rate of complication and are more difficult to completely remove.
The patient's age and overall health prior to surgery may also affect the results. Meningiomas do sometimes recur after surgery or radiation.
Regular follow-up MRI or CT scans (every one to three years) are an important part of long-term care for anyone diagnosed with a meningioma.