- Venous thromboembolism occurs infrequently in meningioma patients receiving combined modality prophylaxis
- Meningioma Treatment
- Radiation therapy
- Rehabilitation Therapy
- Johns Hopkins doctors do brain surgery via eyelid
- Meningioma | Department of Neurology and Neurosurgery
- Why choose Johns Hopkins for treatment of meningioma?
- Our Research
- Meningioma Recurrence
Venous thromboembolism occurs infrequently in meningioma patients receiving combined modality prophylaxis
Volume 109, Issue 2 †
Presented in abstract form at the 11th annual scientific meeting of the society for Neuro‐Oncology, Orlando, Florida, November 16–19, 2006.
Individuals with brain tumors have an increased risk of venous thromboembolism (VTE). Within this population, patients with meningiomas have been reported to have the highest incidence, exceeding rates associated with gliomas and brain metastases.
However, earlier studies did not employ VTE prophylaxis, and VTE were detected with radionuclide scans, the reliability of which has since been questioned.
Therefore, we conducted a retrospective review of postoperative meningioma patients receiving contemporary VTE prophylaxis and diagnostic methods to define the current incidence of and risk factors for symptomatic VTE in this population.
Medical records were reviewed from all patients undergoing craniotomy for meningioma at Johns Hopkins Hospital in 2004 and 2005. The association between clinical characteristics and VTE was assessed using parametric and nonparametric statistical tests and survival analysis.
A total of 224 individuals met criteria for the review. The mean age was 52 years (standard deviation [SD] 14 years), and 167 patients (75%) were women. Median follow‐up time was 230 days (interquartile range [IQR], 89–428 days). VTE was diagnosed in 11 patients (4.
9%; 95% confidence interval, 2.5%–8.6%) at a median of 16 days (IQR, 7–33 days) postoperatively. The development of VTE was associated with older age (mean, 68 years vs 52 years; P = .0001), male gender (P = .
007), and nonambulatory status postoperatively (P< .0001).
VTE occurs infrequently in postoperative meningioma patients who receive combined modality VTE prophylaxis. VTE risk factors in these patients include advanced age, male gender, and nonambulatory status postoperatively. Cancer 2007. © 2006 American Cancer Society.
Individuals with brain tumors have among the highest rates of venous thromboembolism (VTE). Between 20% and 30% of patients with high‐grade gliomas, the most common primary brain tumor in adults, develop VTE.
1-3 The propensity toward clotting in these patients has been attributed to both clinical and biochemical factors, including prolonged operative times,4 hemiparesis,1, 2 and the release of brain‐derived tissue factor, which may cause chronic, low‐grade disseminated intravascular coagulation.5, 6
Whereas the occurrence of VTE in individuals with high‐grade gliomas has been studied extensively, relatively little is known about VTE in patients with meningiomas, the second most common adult primary brain tumor. The few relevant studies4, 7, 8 have concluded that, among intracranial tumors, meningiomas convey the highest VTE risk, with reported rates up to 70%.7
The standard of care has changed considerably in recent years. Patients in these earlier series did not receive pneumatic calf compression or heparin VTE prophylaxis.
Additionally, in some studies all patients were screened for VTE using radionuclide fibrinogen scans, a technology no longer employed because of poor specificity.
9 Therefore, to determine the rate of symptomatic VTE among postoperative meningioma patients receiving contemporary VTE prophylaxis, we performed a retrospective analysis of all patients undergoing craniotomy for intracranial meningiomas at the Johns Hopkins Hospital over a recent 2‐year period.
This study was approved by the Institutional Review Board of Johns Hopkins Hospital. The Johns Hopkins Hospital pathology database was searched for the term “meningioma” over the time period January 1, 2004, through December 31, 2005. Extracranial (eg, spinal, pleural) meningiomas were excluded from the analysis.
For intracranial meningioma cases, we reviewed all available electronic and paper medical records through the date of most recent follow‐up. Generally, patients had routine follow‐up 1 week postoperatively and then every 3–12 months depending on time since surgery and the clinical circumstances.
We collected the following data: patient age, gender, body mass index, ABO blood type, and ambulatory status; duration of operation, estimated surgical blood loss, and presence of significant postoperative bleeding; tumor size, location, and histologic grade; use of mechanical and pharmacologic VTE prophylaxis.
We classified ambulatory status as walking unassisted, walking with assistance, requiring a wheelchair, or bedridden. Tumor size was recorded as the single greatest dimension reported on preoperative magnetic resonance imaging scanning.
We determined tumor location from radiology reports and operative notes.
We grouped tumor locations into the following categories: convexity, falx/parasagittal, tentorium, skull base (sphenoid, planum sphenoidale, CPA, petroclival, tuberculum sellae, olfactory groove, foramen magnum, cavernous sinus), intraventricular, and optic nerve.
Tumor grade was recorded as the World Health Organization (WHO) classification (I‐III) assigned on the operative pathology report. Significant postoperative bleeding was defined as bleeding that required reoperation or caused a change in neurologic status, or both.
To identify VTE, we evaluated in detail the following components of the medical record: relevant diagnostic studies (ventilation‐perfusion scans, contrast computed tomography [CT] scans, Duplex ultrasounds), laboratory data (with attention to abnormal or repeatedly ordered coagulation parameters), hospitalization discharge summaries, and all follow‐up clinic notes (with attention to the narrative of interval events and the list of current medications). Symptomatic VTE was diagnosed using the following criteria: a noncompressible vein on Duplex ultrasound or a pulmonary arterial contrast‐filling defect on spiral chest CT scan. No ventilation‐perfusion scans were performed in these patients. For patients who developed VTE, we collected the following data: postoperative day of VTE occurrence, VTE type (classified as deep venous thrombosis [DVT], pulmonary embolus [PE], or both), VTE treatment, and complications from VTE treatment.
We evaluated the significance of the association between clinical features and VTE diagnosis in univariate analyses using t‐tests, Wilcoxon rank sum, and Fisher exact tests, as appropriate. The significance of the results was confirmed using the log‐rank test with patients stratified by the presence of the risk factor of interest.
We identified a total of 245 patients who had neurosurgical procedures for meningioma between January 1, 2004, and December 31, 2005. Twenty‐one extracranial meningioma cases (20 spinal, 1 pleural) were excluded from this analysis, leaving 224 intracranial meningioma cases in the study population.
Patients were followed for a median of 230 days (interquartile range [IQR], 89–428 days) after surgery, representing a total follow‐up of 189 person‐years. The mean age of patients at surgery was 52 years (standard deviation [SD] 14 years), and 167 patients (75%) were women.
Complete baseline characteristics of the subject population are listed in Table 1.
|Age (y)||53± 14|
|BMI (kg/m2)||27 (24.1–31.3)|
|ABO blood type|
|African American||8 (4)|
|Ambulatory status (at presentation)|
|Ambulatory status (postoperative)|
Linkedin Pinterest Brain Tumor Treatment Brain, Nerves and Spine Brain Tumor
- Chetan Bettegowda, M.D., Ph.D.
A brain tumor diagnosis can be frightening, but if you've been diagnosed with a particular brain tumor called a meningioma, there are reasons to be optimistic.
Meningiomas are the most common kind of brain tumor — accounting for about 30 percent of all brain tumors — and most are treatable. In fact, the majority of these tumors can be removed surgically, and many do not return.
Meningiomas arise from the layers of membrane that cover the brain and spinal cord, not from the brain tissue itself. Some 90 percent of meningiomas are benign — that is, they are not ly to spread throughout the body — and they tend to grow slowly over months or even years.
However, meningiomas can become quite large, and crowd the brain and other structures inside the skull.
Small meningiomas may not cause any symptoms at all. A doctor might discover one incidentally while examining you for an unrelated head injury or for sinus problems.
As meningiomas grow, they increase pressure within the skull and cause problems, such as:
- General pressure inside the head, resulting in headache, nausea and vomiting
- Specific symptoms due to location: For instance, a meningioma pressing against an optic nerve may cause visual problems. Another tumor's location may affect motor skills or speech.
- Electrical disturbances within the brain, causing seizures
Brain tumor treatment depends on the size and location of the tumor. Sometimes, what doctors call watchful waiting or observation, is sufficient for small meningiomas that aren't growing too close to critical nerves or blood vessels, or irritating the brain. Your doctor may have you come in for a brain scan every three to six months for the first year.
Since the vast majority of meningiomas are benign (noncancerous), they are most commonly treated with surgery. Total removal of a meningioma is preferred since it lessens the chances of the tumor returning.
Sometimes radiation can help reduce the size of a meningioma. Radiation may also be considered to treat small remainders of the tumor after surgery. This procedure can also be used when a patient is too ill to undergo surgery.
Your neurosurgeon will carefully assess the size, characteristics and, most importantly, the location of the meningioma.
The best procedure for your situation may involve a craniotomy, which is surgically making a temporary window in the skull and removing the tumor through that opening. The opening is repaired at the end of the surgery. The incision is usually behind the hairline and is not obvious once it heals.
In some situations, your surgeon may be able to reach the meningioma using an instrument called an endoscope, accessing the tumor through the nose.
If the tumor is located close to the surface of the brain near the skull (a convexity meningioma), surgery is more straightforward. For meningiomas located deeper in the brain, the surgeon may need to move the brain tissue aside. Meningiomas can grow into a number of places, including:
- Blood vessels: Meningiomas growing into a blood vessel present problems. The sagittal sinus is a large vein that runs across the top of the brain and eventually, it splits into two jugular veins that extend down the sides of the neck and toward the heart. Meningiomas that have grown into sinuses are very difficult to manage, and the earlier a surgeon operates, the better. This is because the surgery may require clipping or cutting the vessel, which can mean brain swelling or a fatal blood blockage.
In some cases, a surgeon can open up the sinus and remove the tumor, then patch the area using the patient's own tissues or artificial grafts. If the tumor has completely blocked a sinus, it's safe to cut, since the vessel is cut off and other pathways for blood flow have been found.
- Behind the eyes: Meningiomas can grow on the sphenoid wing, a shelf of bone in the middle of the head behind the eye. Tumors located here can become involved with the visual nerves or surround a key artery. Surgery for tumors in this spot can be tricky and demand an experienced neurosurgeon.
- In the base of the skull: Another challenging presentation is a skull base meningioma that grows near the foramen magnum, the large opening at the bottom of the skull where it intersects with the spinal column. Several critical blood vessels and nerves sit at the base of the skull. It is often important to have a multidisciplinary team care for these types of tumors.
Radiation therapy can stop tumor growth, but it's usually not a first-line treatment since it only works in about half of patients with meningiomas and the therapy can make future surgery more difficult.
Sometimes, a neurosurgeon will use radiation on small tumor remnants. It can also be an option for a patient who is too sick to have surgery. Most meningiomas do not respond to chemotherapy.
Of the 30 neurosurgeons at Johns Hopkins' Comprehensive Brain Tumor Center, eight are meningioma specialists working under the Meningioma Center's director, Chetan Bettegowda, M.D., Ph.D.
In addition to treating hundreds of patients, even those with very challenging tumors, the experts at the Meningioma Center are leading research that is redefining the understanding of these brain tumors, their origins and directions for future treatment, including immunotherapy.
Linkedin Pinterest What You Need to Know
- Meningioma is the most common type of primary brain tumor, accounting for approximately 30 percent of all brain tumors.
- These tumors originate in the meninges, which are the outer three layers of tissue between the skull and the brain that cover and protect the brain just under the skull.
- Meningiomas grow the middle layer of the meninges called the arachnoid. They grow slowly and may exist for years before being detected. Sometimes doctors will discover a meningioma incidentally on a magnetic resonance imaging (MRI) scan of the head or spinal cord.
Hollywood stunt woman, Jill Brown, was diagnosed with a benign convexity meningioma brain tumor and searched for the right doctor and medical team across the country. Watch as she recounts what led her to travel across the country to have her surgery performed at The Johns Hopkins Hospital.
- Convexity meningioma grows on the surface of the brain directly under the skull. Accounting for approximately 20 percent of meningiomas, convexity meningiomas may not present symptoms until the tumor has become large enough to push on the brain.
- Falcine and parasagittal meningioma forms in or next to the falx, a very thin layer of tissue between the two sides of the brain.
- Intraventricular meningioma forms within the ventricular system in the brain where cerebrospinal fluid (CSF) is made and distributed. An intraventricular meningioma may cause a blockage of CSF flow, leading to hydrocephalus.
- Skull base meningioma grows in the bones that form the bottom of the skull and in the bony ridge in the back of the eyes. These are more difficult to remove surgically than convexity meningiomas.
- Sphenoid wing meningioma forms on the skull base behind the eyes. Approximately 20 percent of meningiomas are sphenoid wing.
- Olfactory groove meningioma forms along the nerves that run between the brain and the nose and account for around 10 percent of meningiomas. This type of tumor can cause a loss of smell, and can grow large enough to cause problems with vision.
- Posterior fossa / petrous meningioma forms on the underside of the brain and accounts for approximately 10 percent of meningiomas. It can press on the cranial nerves, causing facial and hearing problems. Petrous meningiomas can press on the trigeminal nerve, causing a condition called trigeminal neuralgia.
- Suprasellar meningioma arises from the base of the skull near the pituitary gland and the optic nerve. Tumors in this area can cause visual problems and dysfunction of the pituitary gland.
- Recurrent meningioma: Any meningioma may come back. When a meningioma does recur, it may be the same grade or a more aggressive or malignant form.
At Another Johns Hopkins Member Hospital:
If meningioma symptoms occur, they may be very subtle and start slowly as the tumor grows and presses on the brain or spinal cord.
Depending on the meningioma’s size and location, common symptoms may include:
- Blurred vision
- Weakness in your arms or legs
Other, less common symptoms include:
- Loss of balance
- Hearing loss
- Memory loss
The Johns Hopkins Comprehensive Brain Tumor Center is one of the largest brain tumor treatment and research centers in the world. We tailor each patient's treatment using an array of advanced approaches, including emerging treatments such as tumor-treating fields and MRI-guided laser ablation.
Meningioma is about three times more common in women than in men. The tumors are most common in older patients, with the highest rate in people in their 70s and 80s.
The cause of meningioma is not completely understood, but there are some risk factors:
- Receiving radiation therapy
- Having neurofibromatosis type 2, a rare, inherited (genetic) nervous system disorder. People with neurofibromatosis type 2 often get benign tumors of the nerves throughout the body.
- A physical exam: Your doctor will review your symptoms, personal and family health history, physical exam and tests of vision and reflexes.
- A neurological exam: This includes assessing your vision, hearing, balance, coordination, reflexes and ability to think and remember.
- Scans of the brain: MRI and computed tomography (CT or CAT scans) use computers to create detailed images of the brain and are the most common tests used to diagnose brain tumors.
- Meningiomas have distinct radiological characteristics such as evidence of a dural tail (attachment to the covering of the brain) and indentation of the brain that are ly to show up on these studies.
- Pathological confirmation: If the tumor is removed, a pathologist will examine the tissue under a microscope to determine the pathological cell characteristics and grade.
Observation means seeing a neurosurgeon and having imaging tests done periodically. There are cases in which the meningioma is found incidentally and is causing no symptoms, and the neurosurgeon may recommend watchful monitoring or observation. Treatment may be necessary later, for example, if the tumor grows or symptoms develop or worsen.
The most common type of surgery to remove a meningioma is called a craniotomy. This procedure involves making an incision in the scalp and removing a piece of bone from the skull.
The neurosurgeon can then access and remove the tumor, or as much of the tumor as possible without risk of severe damage to the brain. The neurosurgeon then replaces the bone and closes the incision.
Learn more about surgery for other types of brain tumors.
After surgery, a team of doctors and nurses who are who are specially trained in neurology and critical care will help the patient recover. Before the patient leaves The Johns Hopkins Hospital, they will provide detailed instructions about what to do at home.
Post-surgery, all patients receive a comprehensive assessment for neurological and cognitive needs. Learn more about care and recovery after surgery.
Radiation therapy is the treatment of tumors using X-rays and other forms of radiation (light energy) to destroy cancer cells or prevent the tumor from growing. It is also called radiotherapy.
Radiation therapy may be used to treat meningiomas that are malignant by location, which means that although the tumor itself may not be pathologically cancerous, the tumor's location is dangerous. For example, a meningioma may form around the carotid artery.
Skull base meningiomas can also be difficult to operate on due to their location. In these cases, radiation therapy might be used post-surgery to radiate residual tumor in precise areas of the brain.
Two types of radiation therapy are used to treat meningioma:
- External beam radiation therapy
- Stereotactic radiosurgery
After surgery, a patient may require assistance in recovering. Rehabilitation specialists at Johns Hopkins will provide assistance with physical therapy, occupational therapy, and speech language pathology. Learn more about the rehabilitation services offered at Johns Hopkins Meningioma Center.
To make an appointment or request a consultation, contact the Johns Hopkins Meningioma Center at 410-955-6406.
Johns Hopkins doctors do brain surgery via eyelid
When Liane Lefever complained to her doctor about a persistent ear ache, an examination found a much more serious problem: a brain tumor.
For many Americans, that diagnosis could have led to invasive surgery — including slicing open her skull — and a long recovery. But with an innovative procedure being pioneered by two doctors from Johns Hopkins Hospital, her tumor was removed through a small incision in her eyelid.
“When you tell people you had brain surgery, the first thing people always do is look for a scar, and that's what's amazing, there isn't one,” said Lefever, 47, who lives in Manheim, Pa. “Anyone who needs to go through this should know it's not that big of a deal even if it sounds it is.”
The Hopkins doctors first used the procedure three years ago and it's still relatively rare — there have been only about 18 patientsso far at the hospital.
But the doctors, who published this month the first studies on the procedure, hope to add more patients and varieties of the surgery.
Eventually, they believe, a quarter of tumors could be removed and many other repairs could be made this way.
The method adds another entry point to the brain for surgeons who also are going through the nose, eyebrow and even leg. And it means many more patients with common brain maladies could avoid traditional surgery — as well as its complications and costs.
“In surgery in general, we have a goal of doing things in a simpler way so patients recover more quickly and the cost is less,” said Dr. Kofi Boahene, a facial plastic and reconstructive surgeonand anassistant professor at the Johns Hopkins University School of Medicine who helped pioneer the eyelid procedure. “This is a new concept in minimally invasive surgery.”
Dr. Anand V.
Germanwala, an assistant professot at the North Carolina School of Medicine and a spokesman for the American Association of Neurological Surgeons, said such minimally invasive procedures are still only performed at a few, mainly academic facilities around the nation. Traditional surgery is still most commonly used — and is often the best method because it allows for such a large opening in which to work.
But the quick procedure and the small incision were appealing to Lefever, whose tumor was removed in October.
She had a meningioma, a type of tumor that grows from the protective membranes, called meninges, that surround the brain and spinal cord. After seeking a second opinion, she landed in Boahene's office and in three months, the tumor had doubled in size.
Lefever knew it had to come out.
When the doctors told her they would enter the brain through her eyelid, she was most worried about her vision. But the procedure poses little threat of that, though she did lose some of her sense of smell because of the tumor's location. She was wearing contacts again in three months and back at work at the family french fry business in several weeks.
Eyelids weren't Boahene's first forays into brain surgery. He had worked with Dr. Alfredo Quinones-Hinojosa, a neurosurgeon and associate professor at Hopkins, on the nasal surgery, a procedure pioneered in Pittsburgh in the late 1990s.
But three years ago, a 14-month old boy with a tumor needed a biopsy that could not be accessed through his nose. Boahene began thinking about alternatives to the very invasive, traditional method, which involves shaving the patient's hair, peeling back the scalp, sawing into the top half of the skull and moving around sensitive brain tissue.
As a plastic surgeon, Boahene had been cutting into eyelids for years and knew the location might provide access to the middle and front region of the brain. He approached Quinones-Hinojosa.
The boy's surgery and the 17 others since then have gone smoothly, with patients recovering significantly faster and with less scarring than traditional surgery, and with less infection than with nasal surgery.
Under the minicraniotomy, the eyelid is cut at a crease, and a quarter-sized piece of bone is removed just above the eyebrow.
A computer-guided endoscope fitted with a camera leads surgical instruments to a tumor or a brain fluid leak needing repair.
Once the work is done a few hours later, the bone is replaced and a small metal plate is used to hold it in place. A few dissolvable sutures close the eye lid and leave no visible scar.
Indeed, when Jeanne Fogas bats her eyes, there isn't a hint of her surgery to remove a benign brain tumor a little over a year ago. She wasn't even exactly sure where the incision was made.
Behind her right eye she had a two-centimeter meningioma. It was discovered through a routine MRI. The 59-year-old occupational therapist from Gettysburg, Pa., was referred to the Hopkins doctors.
Her tumor had started to grow and needed to be removed before it affected her vision or caused brain damage, the doctors told her. But the tumor was near her optic nerve and would be tough to reach through her nose or even through traditional surgery.
She was surprised when doctors told her they planned to go through her eyelid.
“I went home [from surgery] in two days, and it looked someone punched me in the eye,” she said. “When I think of the alternative, more invasive surgery, it was nothing.”
She said she has had no pain. For a while she heard the sound of rushing water and kept smelling a strange odor. Occasionally, her eye gets a little puffy. No big deal, she said. She returned to work in less than three months.
Doctors say each patient could have unique side effects depending on the location and type of tumor. Patients could also have complications from anesthesia. But in general the risks are far fewer than traditional surgery.
There aren't accurate statistics on how many minimally invasive brain procedures these are performed annually, according to the American Association of Neurological Surgeons. But last year, there were an estimated 22,070 new cases of brain and central nervous system tumors diagnosed, according to the American Cancer Society and the National Cancer Institute.
The Hopkins doctors say that in coming years they expect thousands to have the eyelid procedure, formally known as a transpalpebral orbitofrontral craniotomy. They describe the procedure in the June issue of the Journal of Otolaryngology — Head and Neck Surgery and in the July issue of Skull Base.
Eventually, the doctors say they may use it on car accident victims, those with other injuries, and particularly, those who have had traditional surgery but require another procedure.
“The transpalpebral approach is a very viable and practical option for thousands of surgeries done each year in the United States that involve problems deeply seated behind the eyes or at the front of the brain,” said Quinones-Hinojosa.
He and Boahene said doctors at several facilities around the country are pioneering other minimally invasive procedures, involving eyelids, sockets and brows, and are building on each others' work. The success stories, which eventually spread to other facilities, will mean many more options for patients, they said.
Among those adopting new procedures is Germanwala, an assistant professor and chief of the section of cerebrovascular and skull base neurosurgery. After training at the University of Pittsburgh Medical Center and at Hopkins, he frequently operates through the nose and has a few times gone in through the eyebrow and eyelid.
In the next decade, advances in research and collaboration are ly to broaden surgeons' tool boxes, he said. Other up and coming areas are robotics, where surgery is performed via computer, and radiation, for which there are new methods that can help patients avoid surgery.
“We're really at the beginning,” Germanwala said. “These are just additional tools in a great bag of tricks we have today. In 15 to 20 years, we'll look back and say, 'Wow, we used to do it that way!'”
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Meningioma | Department of Neurology and Neurosurgery
Meningiomas are tumors that originate in the meninges, which are the outer three layers of tissue between the skull and the brain that cover and protect the brain just under the skull. The middle layer of the meninges, called the arachnoid, is where meningiomas form.
A meningioma may not need immediate treatment and can often remain undetected for many years. However, if it grows, the tumor can cause noticeable problems.
Johns Hopkins' Meningioma Center is part of the Comprehensive Brain Tumor Center, one of the largest brain tumor centers in the world, with expertise in diagnosing and treating all types of brain tumors, including meningiomas.
Our multidisciplinary team of doctors and specialists from several departments within Johns Hopkins Medicine offers patients individualized and comprehensive treatment plans.
To request an appointment with the specialized meningioma team, please call 410-955-6406.
- Meningioma is the most common type of primary brain tumor, accounting for about 30 percent of all brain tumors.
- Meningiomas can grow and press against the brain or spinal cord, causing symptoms such as:
- Blurred vision
- Weakness in the arms or legs
- Problems with balance, hearing or memory
- About 85 percent of meningiomas are benign and most can be removed with surgery.
- Radiation may be used to treat meningiomas in locations that are difficult to reach by surgery.
Why choose Johns Hopkins for treatment of meningioma?
Directed by Dr. Chetan Bettegowda, the team at the Johns Hopkins Meningioma Center works together to provide the safest and most effective treatment possible for patients with meningioma.
Meet Our Physicians:
Nurses and Physician Assistants
Anderson, Jill, MS, PA-C
The Johns Hopkins Meningioma Center offers patients individualized treatment plans including expert surgery. You can be assured of getting the safest and least invasive procedure possible to address meningioma.
Our meningioma research is leading the way toward better understanding the origins and characteristics of meningioma. For meningioma and other types of brain tumor, brain cancer research at Johns Hopkins is creating a fertile environment for innovation and implementation of new therapies to improve survival and quality of life for our patients with brain tumors.
Meningioma: Pat's Story
The changes in her gait, balance and mood were subtle, but Pat noticed them and sought help. An MRI revealed she had an enormous meningioma brain tumor that had been growing for years. Johns Hopkins neurosurgeon Dr. Jon Weingart performed the surgery that changed Pat’s life.
Convexity Meningioma: Jill's Story
Hollywood stunt woman, Jill Brown, was diagnosed with a benign convexity meningioma brain tumor and searched for the right doctor and medical team across the country. Watch as she recounts what led her to travel across the country to have her surgery performed at The Johns Hopkins Hospital.
Chetan Bettegowda, M.D., Ph.D.
If you have been diagnosed with a meningioma and undergone brain tumor surgery to remove it, you're probably eager to get back to your life and put the experience behind you.
Chances are, your neurosurgeon has informed you that you will need to return for regular screening. Why? Because even though the vast majority of meningiomas are treatable, they can return.
It's important to address a recurring meningioma promptly. Problems caused by a tumor pushing on the brain or invading nerves or vessels are more difficult to reverse than they are to prevent.
Meningiomas are tumors that arise from the membranous layers that cover the brain and spinal cord, not from the brain tissue itself. Tumors commonly grow over the years, instead of weeks or months, and can be removed surgically.
Biologically, most meningiomas are benign, but some can be very aggressive and difficult to treat, especially when they surround nerves — such as the optic nerve, affecting vision — or blood vessels — such as the large sinuses that drain blood from the brain.
In one study, almost half of surgically removed meningiomas recurred after 20 years. That's why there needs to be regular monitoring. Though meningioma patients are never completely ” the woods,” you can live a normal life while you're being vigilant with regular brain imaging.
According to meningioma specialist and neurosurgeon Michael Lim, M.D., of Johns Hopkins' Comprehensive Brain Tumor Center, several factors can influence the chance that a meningioma will come back after being treated with surgery alone:
- Was the surgery able to remove all of the meningioma?
- What was the grade of the tumor?
- What were the size and location of the tumor? Was there more than one?
- How old is the patient? Is he or she generally healthy?
After meningioma surgery, your surgeon will arrange for a postoperative scan within a few days of your procedure. This scan helps ensure that the tumor and its attached membrane (the dura) were completely removed. (A new meningioma can arise from the dura if it's not taken out.)
Complete removal of a meningioma and dura is the best way to avoid a recurrence. However, there is still a 24 to 32 percent chance that a meningioma will recur in 15 years, even when the original tumor was completely removed. In about 95 percent of recurrences, the new meningioma grows in the same spot as before.
In some cases, total resection, or removal, is not possible. If a meningioma tumor is not removed completely, it is ly to regrow within 10 to 20 years.
Up to 90 percent of meningiomas are grade 1. This means that the tumor's cells appear indolent (slowly growing) under a microscope and the tumor is not spreading.
Atypical or anaplastic meningiomas tend to involve the brain. They can recur and may also have necrosis (a core of dead cells within the tumor), which is a malignant feature. These tumors are composed of rapidly dividing cells, accounting for their fast return.
Meningiomas that recur more than twice are more ly to be a higher grade. Some can even be malignant.
Radiation therapy can be used to reduce the size of a brain tumor in patients who are too ill for surgery and also destroy tumor remnants that were not able to be removed during surgery.
Radiation therapy for meningiomas can be in the form of conventional radiation or intensity-modulated radiotherapy, a type of external beam radiation that uses computer-controlled radiation beams in conjunction with three-dimensional CT images of the tumor site and surrounding area.
Stereotactic radiosurgery is another type of radiation that can be used on the remaining pieces of meningioma. Usually, patients only require a single treatment. As long as the remaining tumor is not located too close to nerves or vessels, stereotactic radiosurgery is safe and causes little damage to surrounding tissues.
For larger tumors or tumor remains that are close to critical nerves or blood vessels, your doctor may choose fractionated radiation. This procedure involves administering several small doses of radiation over a certain period of time.
In rare instances when a recurrent meningioma becomes malignant, radiosurgery may be recommended. Typically, it takes some time for the tumor to respond to this treatment.
A combination of expertise is important in deciding your treatment plan. The ideal team has experts in neuro-oncology and neurosurgery who are working closely together. You need a group that will help you follow up with regular exams to monitor your condition.
The team at the Johns Hopkins Meningioma Center comprises eight neurosurgeons who conduct weekly conferences, support one another in the operating room and collaborate on research that may lead to discovering new treatments.