About the disease
Meningioma is a tumor, which develops in brain and spinal cord. This type of cancer accounts for almost 25% of all brain tumors. Typically, meningioma is benign and it grows slowly, that`s why in most cases it is operable. In rare cases meningioma can become malignant and in that case not only does it grow quickly, but it also invades surrounding tissues and bones. Malignant meningioma can also metastasize to other parts of body. There are typical and atypical types of meningioma. The only difference is that atypical meningioma requires not only surgery, but also radiation therapy. Meningioma was first described by American neurosurgeon G. Cushing in the early twentieth century. It can be singular or multiple. Multiple meningioma brain tumors in some cases are difficult to treat. Meningiomas are more common in women. Mainly it occurs in adulthood, however, teens and children can also develop it. Meningioma does not always require immediate treatment. Tumors, which are small, do not usually cause any pain. If such tumor does not grow and there are no malignant meningioma symptoms, a patient may never require treatment.
Symptoms
As it was mentioned above, usually meningioma does not cause any symptoms. Symptoms of meningiomas develop gradually and may be very unpronounced. Clinical symptoms include:
- Enlarged skull size
- Increased intracranial pressure
- Tumor`s pressure on other organs
Other signs of brain tumor meningioma are:
- Headache, which gradually becomes stronger. It may be aggravated at night
- Blurred, double vision
- Nausea
- Memory impairment
- Changes in mental behavior
- Seizures
- Weakness in arms or legs, usually on one side
A person can also develop unilateral or bilateral blindness, which happens because of tumor pressure. If there are other problems with vision, one of the eyes can bulge out. There can also be problems with sensitivity and certain mental disorders. If meningioma has paracentral localization, patients experience problems with urination. Lobe meningioma causes speech and hearing disorders
Diagnosis
Diagnosis of brain tumors usually begins with a neurological examination of vision, hearing, coordination and reflexes. Depending on these results a doctor can refer to such diagnostics methods as:
Magnetic resonance imaging (MRI). This is gold diagnostic standard for detecting brain tumors, because it gives clear delineation of cancerous malformation. Doctors can also use MR - angiography, which permits better visualization of blood vessels, that are supplying growth of tumor. Computed tomography renders most meningiomas, but right now this method is coming out of use because of more modern diagnostic techniques. To confirm histologic type of tumor, doctors do biopsy. This procedure studies segments of tumor tissue under a microscope. A biopsy can be performed both before surgery and during surgery, when part of the removed malformation is sent for histological examination. Properly defined type of tumor is crucial for the final choice of treatment.
Treatment
- Surgical treatment is primary choice for meningioma treatment, because only during surgery neurosurgeon can remove the tumor completely. However, in some cases, if tumor is located near vital structures, it is not always possible to remove it completely. In such cases, surgeons try to remove as much of cancerous malformation as possible. This can lead to future tumor recurrence (approximately 10% of cases) and then patients would have to either have second surgery or course of radioactive therapy. Furthermore, there is always a risk of infection and internal bleeding after surgical intervention. To minimize complications, surgery is usually performed under operating microscope with neuronavigation control and ultrasonic aspirator. Recovery period after surgery usually takes several months.
- Radiosurgery is a type of radiation therapy, in which a powerful beam of ionizing radiation is directed at a specific point inside human body. Radiosurgery may be choice for people with meningiomas, which can not be removed by conventional surgery. Even though radiation therapy is effective, it has many side effects, such as fatigue, weakness, nausea, hair loss. Brain tissue may also swell considerably after radioactive intervention, which means that headaches may become even more severe and unbearable. In that case a patient is prescribed special analgesics that can ameliorate pain. Radiosurgery is also likely to cause some kind of necrotic processes, when not only malignant cells die, but also healthy ones. Radiation therapy is prescribed sometimes along with chemotherapy. Radiosurgery is usually carried out in several sessions. Radiation therapy increases likelihood for longer life span for each patient with meningioma brain tumor. In some cases neurosurgery uses modern treatment called gamma knife to eliminate the number of cancerous cells. Such treatment can sometimes be used instead of surgery, if meningioma case is not too severe.
- Radiotherapy is recommended after or before surgery.
Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko
