- Does the location of my meningioma make a difference?
- What are my chances of a cure with a meningioma?
- Are there options to try before deciding on surgery?
- What role do I, as the patient, have in the treatment decision?
- Which other therapies are effective, if my tumor cannot be removed by surgery?
- Why is radiation therapy used to treat my meningioma?
- What types of radiation are used to treat my meningioma?
- What medications will I receive before or during surgery?
Does the location of my meningioma make a difference?
Yes. If the tumor is near the surface and has not invaded deep structures or major blood vessels, then resection (tumor removal by surgery) is less complex. If the meningioma is invading large draining veins, major arteries or the brain surface, then complete removal becomes more complex.
What are my chances of a cure with a meningioma?
The location of the tumor is the most important elements in predicting a successful result. The goal of the operation is to remove the meningioma totally, including the fibers that attach it to the coverings of the brain (dura) and bone.
Even though the goal of surgery is to remove the tumor, the first priority is to preserve or improve your neurological function. For patients in whom total removal of the tumor carries significant risk of morbidity (any side effect that can cause decreased quality of life), it is better to leave some tumors in place. In this case, the patient would be observed over time, and in some patients the tumor may remain stable indefinitely. In others, surgery at a future date or radiation therapy may be used.
Are there options to try before deciding on surgery?
The options of observation, radiosurgery should be considered in many cases. Not every patient with a meningioma needs an operation. In some patients, periodic evaluation with regular MRI scans is a reasonable course to follow.
Those patients for whom observation alone is sufficient include:
- Those with few symptoms and little or no swelling in the adjacent brain areas
- Patients with mild or minimal symptoms who have a long history of tumors without much negative effect on their quality of life.
- Older patients who have very slow-progressing symptoms.
- Patients for whom treatment carries a significant risk.
- Patients who choose not to have surgery after being presented with all the options.
What role do I, as the patient, have in the treatment decision?
It's important to carefully weigh the short and long-term benefits and risks of the various treatments. For many patients surgery is clearly indicated because of increasing disability and because MRI scans show a surgically treatable tumor. Of course the assessment should be made that surgery can be done with an acceptable degree of risk.
Which other therapies are effective, if my tumor cannot be removed by surgery?
Radiation therapy (X-rays to the tumor area), or radiosurgery have all shown positive results.
Why is radiation therapy used to treat my meningioma?
Radiation therapy has been shown to slow or stop the growth of some meningiomas. It is often used to treat fragments of tumor left behind by the surgeon, or a tumor that has recurred or tumors that could not be treated surgically because of their location.
What types of radiation are used to treat my meningioma?
External-beam radiation (X-ray) therapy has been effective if given in daily fractions delivered over 5-6 weeks. The complication rate is low, but care must be taken with treatment near the optic nerves and brainstem.
Radiosurgery (in a single or few divided daily doses) has also been effective. The incidence of complications has been low.
Experience with proton-beam irradiation has been limited but arrest of growth of meningiomas has been reported.
What medications will I receive before or during surgery?
Most patients are given steroids for at least 48 hours before surgery, and longer if there is significant brain swelling (edema). After surgery, the steroids are tapered off over 5 or more days, depending on the degree of edema and the patient's condition.
For most operations on the front or top part of the brain, an anti-seizure medication is given before or during surgery.
Intravenous antibiotics are given before operation and for 24 hours after the procedure.
A central venous line (plastic catheter in the arm or leg vein) is placed. After beginning anesthesia and inserting a catheter into the bladder to drain urine, a drug to reduce swelling called "mannitol" is given to further reduce brain swelling.
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