June 08, 2012
Michael Schulder, MD
As reported in the news recently, singer Sheryl Crow has been diagnosed with a benign tumor called a meningioma, a tumor that occurs outside of the brain. These tumors grow from the lining of the brain, inside the skull known as the dura mater, making them less severe of a problem than tumors that arise within the brain itself. Moreover, most meningiomas are benign tumors, meaning they almost never spread outside of the head, and patients can be cured by surgery. In the United States, about 10,000 people a year are diagnosed with a meningioma.
While most meningiomas can be treated with surgery, not all meningiomas can be removed safely. If the tumor appears attached to critical structures such as the brainstem or optic nerves, in some cases it is much better for the surgeon to remove only as much of the tumor as can be done safely. As meningiomas usually grow slowly, performing a “subtotal removal” may relieve a patient’s symptoms for many years. An excellent alternative for many patients is to be treated with a non-invasive method called stereotactic radiosurgery (SRS). This technique, invented 60 years ago, uses highly focused radiation beams to treat small tumors in one or several treatment sessions. Nearly 95 percent of the time, patients with meningiomas who receive SRS will have their tumor controlled.
Additionally, not all meningiomas are benign. A small percentage (1 to 2 percent) of these tumors are malignant; they tend to grow back even after surgery and radiation. A larger fraction, maybe 30 percent, is deemed “atypical.” These tumors have some tendency to re-grow despite surgical removal, although not in all cases. For this reason, we still don’t know for sure if patients with “atypical” meningiomas need radiation therapy after the tumors are removed, although there is an increasing tendency to offer this treatment.
A final consideration is that many if not most meningiomas are diagnosed as “incidental findings” – in other words, they are found on an magnetic resonance imaging (MRI) or computed tomography (CT) scan done for unrelated symptoms. In such cases, it is often best to do nothing beyond getting follow-up MRI scans, and to reserve surgery only if the tumor clearly enlarges over time. That is why most people with meningiomas never actually get surgery. So the bottom line is, if you or your loved one has a meningioma, you have some very favorable options to consider. Full Post - to Detail View