Meningiomas are tumors that originate from the meninges, which are membrane-like structures that surround the brain and spinal cord. Typically, they are benign and occur as solitary masses, but instances of malignancy and multiple concurrent lesions have been reported. About 15 to 20% of all primary brain tumors are meningiomas and commonly occur in the fourth through the sixth decade of life, mostly affecting women. Despite various theories, the origin and cause of the tumors is unknown.
Since the meninges surround the entire brain and spinal cord, meningiomas can occur anywhere in the central nervous system. Signs and symptoms depend on the size and location of the tumor. Symptoms usually develop as a result of compression of surrounding neurovascular structures. Intracranial meningiomas may manifest as headache, stroke, seizure, loss of vision or personality change. Meningiomas of the spinal cord may present with pain or weakness at the level of cord involvement. Due to their slow growth characteristics development and progress of symptoms can be subtle and extend over a period of years.
Diagnosis begins with a thorough documentation of the patient's medical history, including a detailed description of the onset and duration of the symptoms and a complete physical examination focused on neurologic findings. Laboratory results do not play a major role in diagnosis, but radiologic studies are instrumental in defining the extent of a lesion. Although CT scans may be helpful as an initial diagnostic tool, magnetic resonance imaging (MRI) scans provide the best anatomical pictures of meningiomas and their relationship to surrounding structures.
Treatment options vary, ranging from conservative expectant therapy to aggressive surgical resection. Therapy must be tailored to the needs of the individual patient. Elderly patients or those with multiple diseases who are at greater risk for surgical procedures may benefit from observation with periodic MRI studies, radiation therapy or radiosurgery.
Indications for surgical resection depend on clinical progress and the size and location of the tumor. In critical patients with worsening symptoms, resection of the mass is a priority. Advances in diagnostic tools, neuroanesthesia, surgical instrumentation and innovative surgical techniques have enabled surgeons to offer resection to a greater number of patients with less associated surgical risk.
The goal of surgery is complete tumor removal. The technique employed depends on the location of the tumor. When the tumor cannot be completely resected at the time of surgery, adjuvant radiotherapy or radiosurgery may play a role in subsequent management of the patient.
Tumors once thought to be "unresectable" are now regularly and safely removed. Meningiomas located at the base of the (cranium) skull are very difficult to access. Our use of highly specialized surgical techniques, sophisticated intraoperative monitoring equipment and minimally invasive surgical instruments allows us to expose hard-to-reach areas in their entirety without disturbing surrounding critical neurovascular structures.
Patient outcomes depend on the nature of the tumor and the therapeutic plan that is followed. It is difficult to summarize all treatment results, but the range of treatment options that are currently available provides a suitable approach to most every individual case.
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