Diagnosis and Treatment of Meningiomas
Understanding Meningiomas
A meningioma is usually a benign, non-cancerous tumor that arises from the meningeal tissue that surrounds the brain and spinal cord. Most meningiomas are reported to be slow-growing and benign, but some meningioma cases present with symptoms due to exerted pressure on adjacent brain tissue or nerves. Common symptoms that patients with meningiomas report include headaches, seizures, visual disturbances, balance or coordination problems, weakness or numbness in limbs.
Preparing for Surgery
In preparation for surgery,the patient would present to John Muir–Walnut Creek and will initiate pre-operative evaluation and imaging. With pre-operative evaluation, the patient will meet Dr. Yim, the anesthesiologist, and the surgical team and then the patient will have their medical history, blood tests, and anesthesia plan all reviewed. Next, the patient should expect to undergo preoperative imaging which usually consists of MRI or CT imaging studies that will assist the surgical team locate and characterize the tumor, to ensure no changes have occurred since the previous visit.
The Surgical Procedure
The overall surgery involves a craniotomy, which is a procedure involving the temporary removal of a small portion of the skull in order to access and carefully remove the tumor. During surgery, Dr. Yim utilizes advanced technologies like microscopic visualization and neuronavigation in order to optimize safety and accuracy. The surgery typically lasts for 3 to 6 hours, depending on a case to case basis.
Postoperative Care
In regards to postoperative care, the patient will recover in the Neuro ICU at John Muir Walnut Creek under specialized care. The surgical teams and Dr. Yim will prioritize updating the patient’s family immediately after surgery and will continue to monitor the patient’s neurological function, pain relief, and any medications. It is recommended that most patients remain hospitalized for approximately 1 to 3 days.
Recovery and Going Home
After discharge from the hospital, the patient will receive detailed instructions regarding medication management, what activities are recommended and are limited, how to properly care for the incision, and scheduling follow-up appointments. It is vital for patients and their families to understand how to properly care for healing an incision wound and also knowing how to schedule a follow-up appointment within a week to monitor progress of the surgical procedure.
Risks and Complications
The patient could have complications arise during post-operative care. Overall, there is a 1-5% chance of infection, 1-3% chance of bleeding that requires additional surgery, 5-10% chance of seizures, 3-10% of facing neurological deficits, and 10-15% chance over the span of 10 years to have recurrence of tumor after complete resection. Dr. Yim will discuss these potential complications and your specific individual risk factors before the surgery as well.
Long-term Outlook
Meningioma: Location, Size, and Surgery
Location
Meningiomas usually stem from the tissues and membranes surrounding the brain or spinal cord, but the specific location that they arise from significantly influences whether surgery is recommended and the other risk factors that are involved. There are two classifications of meningiomas in regards to location. Superficial meningiomas are tumors that are located near the surface of the brain and these tend to be easier to access and remove. Surgery could be highly recommended since surgery is highly successful with a low risk of complications. Deep or skull-base meningiomas differ as they are located deeper and possibly near more critical brain structures. These will most likely require specialized surgical techniques and would have a higher risk of complications.
How Size Influences Your Risks
The size of meningiomas are also classified between small, medium, and large meningiomas. These classifications greatly contribute to assessing the severity of symptoms, urgency of surgery, and other potential risks.
A small meningioma is sized less than 2 cm and these are usually monitored without immediate surgery unless they cause severe symptoms or grow significantly. Regarding surgery, smaller tumors will present lower risks and shorter recovery times.
A medium sized meningiomas measures in between 2-4 cm and these tumors usually cause symptoms due to an increased pressure on surrounding brain structures. Surgery will most likely be recommended to relieve symptoms and prevent further neurological complications.
A large sized meningioma measures anything larger than 4 cm. These tumors always tend to cause significant symptoms and usually require surgery. Although surgical removal is intended to significantly improve symptoms and outcomes, they do have increased risks due to their size.
Indications for Surgery
When a meningioma presses on brain regions and causes symptoms, Dr. Yim usually suggests surgery. Surgery would also be recommended if the imaging shows that it is expanding dramatically over time. If treatment is not received, the tumor’s size or placement could impair critical brain functions and this would be discussed as complication when discussing surgery options.
Potential Risks Related to Location and Size
The risks of surgery vary significantly depending on where the tumor is located and its size. The superficial and small tumors usually have lower complication rates. But with the deep and skull base tumors, there would be an increased risk of neurological complications, such as difficulties with speech, vision, or movement.
Personalized Surgical Planning
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