Understanding Skull Base Surgery for Meningiomas

May 26, 2015 Brigham and Women's Hospital

Pre-operative MRI of a meningioma

In observation of Brain Tumor Awareness Month, this post was written by Dr. Tracy Ansay and physician assistant Stanley Mui of the Department of Neurosurgery at Brigham and Women’s Hospital. Dr. Ansay provides pre- and post-surgical patient care at our practice in South Weymouth. She also performs surgery at South Shore Hospital in South Weymouth, as well as our main hospital campus in Boston.

Meningiomas are one of the most common brain tumors within the general population. Meningiomas make up about 14 to 19 percent of all brain tumors. They are more common among women and occur with increasing frequency as people get older. Meningiomas are found in about three percent of people over the age of sixty.

MRI after skull base surgery to remove the meningioma

Meninigiomas are typically attached to the covering of the brain called the dura, and they originate from cells within it. Approximately 90 percent of meningiomas are benign tumors. They also are slow-growing, with a growth in diameter of about one millimeter per year. Atypical meningiomas, which grow more quickly, make up about seven percent of meningiomas. Malignant meningiomas, which are very rare, account for about two percent of meningiomas. Because meningiomas are usually benign and slow-growing, most patients can expect good outcomes after treatment.

Due to their attachment to the dura, meningiomas typically cause pressure on the brain, but do not actually invade brain tissue. Symptoms vary depending on where they are they located and may include weakness, numbness, or seizures. Most patients, however, do not experience any symptoms.

We recently cared for a patient who was experiencing seizures despite being prescribed anti-seizure medications. He also was experiencing bouts of confusion. Both the seizures and episodes of confusion were very debilitating and impacted his performance at work. He was not able to drive and also was experiencing side effects from the anti-seizure medications, including irritability, cloudy thinking, and fatigue. An MRI indicated he had a meningioma located in an area deep within the brain, next to an area called the cavernous sinus. His seizures were the result of pressure to the temporal lobe caused by the meningioma.

Despite the challenging tumor location, our team was able to successfully remove this patient’s meningioma, with minimal disruption to the surrounding brain tissues, using a modified skull base surgical procedure. By using a less invasive surgical approach, our patient was able to return home two days after his surgery. We also were able to perform this complex surgery in a community setting at South Shore Hospital.

Examination of the patient’s tumor indicated that it was benign. Follow-up MRI scans confirmed the tumor was completely gone and had not regrown. Our patient is being tapered off his anti-epileptic medications, and his bouts of confusion and seizures have stopped. Most importantly, he has been able to resume his normal activities and enjoy life once again.

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