Meningioma of the brain: treatment/removal forecast
Meningioma is a neoplasm of soft or arachnoid membranes of the brain or spinal cord. The tumor is a quarter of all intracranial neoplasias and is the second most spoken language, second only to gliomas. More common in young and elderly, the average age of the patients 40-70 years of age, and children diagnosed with meningioma is extremely rare. Among the patients are women. The meningioma may recur, to have multiple growth, which significantly worsens the prognosis and quality of life of patients.
Meningioma in the vast majority of cases are located in the cranial cavity, on the surface of the brain, but can affect and in-depth education, brain ventricles, structures of the skull base. The location of the neoplasia determines the clinical picture, prognosis and the nature of the treatment.
The tumor is benign, but its growth inside the skull often makes them dangerous, because the space for growth is limited, and around – the tissue of the brain and important nervous centres. Malignant counterparts meningiomas seldom are diagnosed and characterized by rapid growth, damage to the brain cells and poor prognosis.
Meningioma brain does not always produce symptoms, especially at small sizes. The initial stage of growth of the tumor asymptomatic, so it can be detected accidentally when passing the CT or MRI. The tumor grows slowly and is not prone to malignancy.
The brain is covered by three membranes: soft, tightly enveloping the brain from the outside, the arachnoid, containing a large number of vessels, and solid, which is tightly adherent to the skull bones. Soft and arachnoid sheath are sometimes combined in one – leptomeninges. The source of the tumor becomes soft and arachnoid sheath. Quite a common misconception that the tumor originates in the solid shell of the brain, and such data is presented in many online sources. Objective data and the existing scientific view reject the origin of the tumor from the Dura.
Meningioma of the spine, signifying the defeat of the membranes of the spinal cord, occurs several times less than intracranial. The tumor grows slowly, initially without giving specific symptoms, but the likelihood of transverse lesions of the spinal cord with paresis, paralysis and loss of feeling is not allow to ignore the tumor and require timely removal.
The causes of meningiomas
The exact cause of meningiomas is unknown, but to predispose to its occurrence can:
- Genetic anomalies;
- Female gender and age over 40 – hormones of the female body can cause tumor growth and during pregnancy existing meningioma is often increased;
- Traumatic brain injury;
- Ionizing radiation.
Genetic abnormalities associated with a defect in chromosome 22, which is also characteristic of neuromas and neurofibromatosis when affects the peripheral nerves. There is evidence that meningioma occurs three times more often in women, however, men often are diagnosed with malignant counterparts of the tumor.
Traumatic brain injury can trigger the growth of so-called post-traumatic meningiomas, when the damage of the meninges causes increased proliferation of cells in response to damage. Symptoms of such a tumor is not different from other types of meningiomas.
Irradiation contributes to a higher risk of all intracranial tumors and meningiomas in particular. It is proved that the value has a lower radiation dose.
Externally, the meningioma appears in the form of a single dense node, a well demarcated from the surrounding tissue, but tightly associated with the membranes of the brain, including solid. Its size ranges from a few millimeters to half a cm or more. At a superficial location to be diagnosed with larger tumors because of the deep growth of even small tumors exert pressure on nerve structures and cause corresponding symptoms, causing the patient to go to the doctor.
Depending on the behavior and structure of the tumor, distinguish benign meningioma, atypical and malignant meningioma.
The latter is manifested invasive growth penetrating into the brain tissue, can metastasize, to give relapses. Benign meningioma is the most identified tumors, manifested by slow growth and sometimes a recurrence. Atypical meningioma is an intermediate position between the benign and malignant varieties. It grows quickly, can recur and infiltrate the nervous tissue.
In accordance with the classification of the world Health Organization, meningiomas are of three types. The first involves benign tumors that grow slowly, rarely recur, and constitute more than 90% of all meningiomas. The second type includes atypical tumors, the prognosis of which is less favorable due to active growth and high recurrence rate, and the third is malignant meningiomas that grow brain tissue, recurrent and metastatic.
Signs and diagnosis of meningiomas
A meningioma grows slowly and a long time may be asymptomatic, especially with the localization on the surface of the brain. As more tumors are showing signs of increased intracranial pressure: headache, nausea, convulsions, disturbance of consciousness. Neurological symptoms determined by the localization of the neoplasias and compression of specific structures of the brain. Often suffers from hearing, vision, sensory and motor areas, developed hydrocephalus (water on the brain).
Signs of a meningioma are:
At least one such symptom should always guard against the possibility of tumor growth and serve as a reason for going to a specialist.
Symptoms of cancer of the surface of the brain is usually reduced to intracranial hypertension and convulsions. Patients experience severe headaches, especially at night and in the morning. The pain is aching or bursting spilled.
When the meningioma frontal lobe changes the psyche and behavior of the patient. He stops to evaluate ourselves and the environment, are prone to aggression and an unexplained, unmotivated things. Possible thought disorder, vision disorder and loss of smell, seizures.
The defeat of the temporal and parietal region is fraught with disorder of hearing, ability to perceive and reproduce the speech, impaired motor areas (muscle weakness, paresis and paralysis on the opposite side of the tumor).
The so-called parasagittal meningioma located in the region of the sagittal sinus, passing longitudinally from the front to the back of the brain. The nature of the symptoms depends on the area in which there is a tumor. Perhaps the defeat of the frontal lobes with disorders of thinking and memory, seizures; parietal region of the brain with characteristic movement disorders up to paralysis, dysfunction of the pelvic organs, and convulsive syndrome. Parasagittal meningioma occipital region manifested intracranial hypertension, possible hearing loss, and cerebellar disorders (changes in gait, coordination of movements).
Meningioma of the cerebellum is manifested by impaired coordination of movements and balance, unsteadiness of gait, signs of intracranial hypertension. In the case of compression of the brain stem appear swallowing, functions of the cardiovascular system, breathing disorders, which can be dangerous for patient’s life.
Meningioma tubercle Turcica affects the optic nerves and chiasm, causing visual disturbances the flesh to complete blindness, double vision, loss of visual fields. When the tumor in the ventricles of the brain or near them is obstruction of cerebrospinal fluid pathways and hydrocephalus develops when excess cerebrospinal fluid accumulates in the cranial cavity and the ventricles of the brain.
Meningioma can be formed not only in the brain but in the spinal cord, hitting his shell on a different level. The characteristic symptoms of meningioma of the spinal cord are considered pain associated with compression of spinal roots, a sense of numbness, paresthesia in the area of the affected area of the spinal cord. Meningioma is able to compress the tissue of the spinal cord, there develops a syndrome of cross lesion with characteristic disorders of sensory and motor functions. A meningioma grows slowly, so a complete violation of the movements (plegia) occurs on average one and half to two years if untreated.
Are often nonspecific signs of tumor, such as unexpressed changes in memory, attention, headaches are written off to older patient age, and tumor «hiding» under the diagnosis of dyscirculatory encephalopathy. With intensification of the symptoms and signs of focal lesions of the nervous system there is a need in the neurological examination and the exclusion of intracranial neoplasms.
Diagnosis of meningioma requires the participation of a neurosurgeon, neurologist, and in some cases, an ophthalmologist and Laura. To confirm the diagnosis the patient is carried out:
- Ophthalmological examinations (visual acuity, ophthalmoscopy);
- Histological examination of tissue meningiomas (made after its removal).
Treatment of meningioma
Treatment of meningioma include:
Elderly patients with a high risk of surgical complications, in the absence of symptoms and a small tumor size may occur at the doctor provided regular monitoring of the tumor size.
If the meningioma is located deep, but small and asymptomatic, then in such cases you can also observe the situation. If signs of tumour growth or any symptoms will put the question on necessity of removal of the tumor.
The main treatment of meningiomas is surgical removal. At a superficial location of the tumor surgery give a complete cure and removal of such education usually is not too difficult: the surgeon performs a craniotomy and excised the tumor. If necessary, is made of plastic formed defect own tissues or synthetic materials. During neurosurgical operations involves microscopic equipment, systems visualization and monitoring of the intervention.
If the tumor is adherent to the surrounding tissues, it is tightly prilezhat vessels and nerve fibers, the operation may be difficult and dangerous, and complete removal of the tumor tissue becomes impossible. In such cases, you can leave part of the tumor, and to stop its further growth to complement surgery, radiation therapy.
If deep location of meningiomas makes it inaccessible to the surgeon’s scalpel or the risk of brain damage and blood vessels in attempt removal of the tumor is extremely large, the preference for radiosurgical methods of influence.
Standard radiation therapy is less frequent, giving place to more modern methods of treatment. Under normal irradiation is a possibility of local reaction (radiation dermatitis, hair loss) in the zone of action of radiation and tumor growth require more than one session of irradiation, and the treatment can take several weeks. In addition, the meningioma is not too sensitive to external beam radiotherapy.
More modern and very effective is the treatment of meningiomas with radiosurgery (gamma knife, CyberKnife, NOVALIS system). This method implies getting a large dose of radiation directly to the tumor, avoiding the surrounding healthy tissue. The effectiveness of the procedure exceeds the normal radiation therapy, reaching 90% or more. In rare cases requires re-session radiosurgery, but usually stop your tumor growth and regresses after just one treatment.
Treatment without surgery is indicated to patients who cannot be surgically remove the tumor because of its deep location and the risk of complications. When the patient’s condition and the presence of comorbidity, when an operation and General anaesthesia is extremely undesirable or contraindicated, radiosurgery is becoming the method of choice.
The disadvantages of radiosurgical removal of the tumor can be considered a limitation on the size of the tumor (30 mm) and delayed effect. Regression of the lesion is gradual, taking up to a year or more. However, the method is painless, requires no preparation and postoperative rehabilitation. Moreover, such therapy can be performed on an outpatient basis and the patient is not necessary to change the rhythm of life.
Radiosurgery is often combined with traditional surgery. For example, a tumor of large size cannot be removed completely during surgery, and radiosurgery but it not eliminate. In such cases, there may be a partial excision of tumor tissue followed by irradiation of the remaining fragments of meningiomas.
In addition to the direct removal of tumor tissue patients in need of symptomatic therapy aimed at the elimination of brain edema and the inflammatory process. For this purpose, prescribers from the group of corticosteroids (prednisone, dexamethasone). In the throes of a mandatory anti-convulsants. Intracranial hypertension usually does not require specific treatment, as it is eliminated, as only the tumor is removed from the skull.
The prognosis after treatment of meningiomas depends on the type of tumor, its location, size and condition of the patient. Small meningiomas that do not violate the function of the brain, can be completely cured. If the tumor has signs of atypical structure or malignancy, the prognosis becomes significantly worse 5-year survival does not exceed 30%. Poor prognosis differ multiple tumors.
In the presence of diabetes mellitus, pathology of the cardiovascular system, the elderly, the deep location of the tumor, fused with the surrounding nervous structures, and also at unsatisfactory results of previous treatment and relapse, the chances of a cure are lower.
Consequences meningiomas can be various neurological symptoms in cases of irreversible damage of brain tissue. Neurological disorders, disorders of thinking, memory, vision can remain after surgery, if the tumor was large and leading to permanent atrophy of certain areas of the brain. In addition, the operation may be accompanied by impaired blood flow in the brain and infection.
Life expectancy of patients with meningioma depends on the type of tumor, its location and the effectiveness of treatment. In benign formations, located in the region of the cranial vault, removal means and curing, but still the risk of recurrence is (about 3% of cases). Malignant forms of tumor are very dangerous, and the treatment prolongs the lives of patients at two to three years.
Specific measures for the prevention of meningiomas no. It is important to lead a healthy lifestyle, eliminate bad habits and possible exposure to ionizing radiation. Patients who have undergone treatment for meningiomas that should be observed by a neurologist and undergo regular MRI to monitor the condition of the brain and the likelihood of a resumption of tumor growth.