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Special mention of tumors
B. Meningioma
Meningiomas are the second most common primary tumour of the central nervous system, arising from the arachnoid "cap" cells of the arachnoid villi in the meninges . These tumors are usually benign in nature; however, they can be malignant
Meningioma can be familial (Neurofibromatosis) or can be sporadic. Other causes trauma, radiation
Signs and symptoms
Small tumors 2.0cm or less are usually incidental findings and usually does not cause any signs and symptoms. Larger tumors can cause symptoms depending on the size and location.
- Seizure may be caused by meningiomas that overlie the cerebrum
- Weakness of the limbs may be caused by tumors growing in the motor cortex.
- Raised intracranial pressure due to a tumour of large size but is less frequent than in gliomas.
Diagnosis
Meningiomas are readily visualized with contrast CT, MRI , and arteriography, all attributed to the fact that meningiomas are extra-axial and vascularized. CSF protein is usually elevated if lumbar puncture is attempted.
Treatment
Observation
For a small tumour a regular close follow up with the patient with periodic imaging can be done. This is only possible when the tumor is small and patient does not have any neurological deficit.
Observation is not recommended in tumors that are already causing symptoms. Furthermore, close follow-up with imaging is required with an observation strategy to rule out an enlarging tumor.
Surgical resection
Meningiomas can usually be surgically resected with permanent cure if the tumor is superficial on the dural surface and easily accessible. Transarterial embolization has become a standard preoperative procedure in the preoperative management. If tumor is not accessible or adherent to a vital structure total removal is nearly impossible. Malignant transformation is rare.
The probability of tumor recurrence or growth after surgical resection can be estimated by the tumor's WHO Grade and by the extent of surgery by the Simpson Criteria.
Radiation therapy
Radiation therapy may include Gamma Knife, proton beam treatment, or fractionated external beam therapy. Radiation therapy is often considered for WHO Grade I meningiomas after subtotal (incomplete) tumor resections.
In the case of a malignant meningioma, the current standard of care involves post-operative radiation treatment regardless of the degree of surgical resection.[19]This is due to the proportionally higher rate of local recurrence for these higher grade tumors.
Conventional chemotherapy
Current chemotherapies are likely not effective. Antiprogestin agents have been used, but with variable results. Recent evidence that hydroxyura has the capacity to shrink unresectable or recurrent meningiomas is being further evaluated.
Team of Specialists:
- Dr. Arun Saroha Head - Neurosurgery (Unit I) View Profile
- Dr. Alok Gupta Head - Neurosurgery (Unit II) View Profile
- Dr. Praveen Gupta Head - Neurology View Profile