Not every patient requires surgery for meningioma, however many patients will. The treatment path your doctor recommends will depend on a number of factors, including your individual health condition and the characteristics of your tumor. By learning more about meningioma treatment options and when one may be preferred over another, you can develop a better understanding of your upcoming procedure and why it is the most suitable option in your case.
There are two general treatment categories of meningioma: traditional surgery and stereotactic radiosurgery. Each may be used alone or in combination, depending on your treatment needs. There are several factors that your doctor may take into consideration to develop a treatment plan and the following information will help you better understand each individual procedure.
Surgery for Meningioma
Surgery for meningioma takes place in a hospital under general anesthesia, and you can expect to spend at least three days there following your procedure, allowing your care team to monitor your immediate recovery.
During the procedure, your surgeon will perform a craniotomy, removing a small section of your skull, providing access to your tumor. Your surgeon will carefully remove as much of the brain tumor as he or she can. Sometimes it is possible to remove the entire tumor, but partial tumor removal is often necessary.
Once the tumor is removed, your surgeon will replace the piece of bone, using a plate or screws to secure it in place. Your incision site will be closed using sutures or staples. You will be closely monitored in the post-op room until your doctor determines you are stable and you will be transported to your recovery room.
Despite the name, stereotactic radiosurgery is not surgery in the traditional sense, but is instead a specialized form of radiation therapy. Using computer imaging, your doctor delivers a focused beam of radiation directly to the tumor from multiple angles. An advantage of stereotactic radiosurgery is that the tumor can be targeted specifically, sparing the healthy surrounding tissue. The result is fewer of the unpleasant side effects that are often associated with radiation therapy.
Stereotactic radiosurgery is an outpatient procedure and the number of visits required can vary. In some cases, it may be used alone as the primary mode of treatment or it may be used following meningioma surgery to eliminate any remaining tumor and prevent recurrence.
What Affects My Treatment Decision?
Though your doctor will take multiple factors into consideration, two key elements are the grade and location of your tumor. These characteristics are part of your meningioma diagnosis and will strongly influence whether you undergo surgery, stereotactic radiosurgery or a combination approach.
The grade of your meningioma is based on what the actual cells of your tumor look like under a microscope. This classification system is used to describe many different types of tumors, not just meningiomas, so it may be terminology you are familiar with.
Meningiomas can be Grade I (benign), Grade II (atypical) or Grade III (anaplastic). The higher the grade, the more aggressive the tumor. Over 90 percent of meningioma tumors are Grade I, which do not invade local tissues or spread elsewhere in the body. These tumors will often still require treatment because of the pressure they put on the brain, which leads to a variety of symptoms.
Grade I meningiomas may be monitored and left untreated, or your doctor may recommend surgery and/or stereotactic radiosurgery. Size will be a major factor in your Grade I meningioma treatment options. If your tumor is small, stereotactic radiosurgery alone may be an option as a primary method of treatment.
Grade II and III meningiomas are more aggressive. The cells that make up the tumor are able to grow more quickly and are different from normal cells, allowing them to spread into surrounding tissues, such as the brain.
If your meningioma is classified as Grade II or III, your doctor will likely recommend surgery for meningioma to remove as much of the tumor as possible, followed by radiation therapy. Because these tumors are aggressive and more likely to recur, radiation therapy may be necessary following surgery to ensure all the tumor cells have been removed.
The location of your tumor will also dictate much of your treatment planning process. Because of the delicate nature of the brain and spinal cord, it is possible that your tumor is in a location that increases the risk of surgery. In this case, your doctor may choose to only remove part of your tumor or you may not be a candidate for surgery at all, necessitating radiation therapy.
If your tumor is near the brainstem, optic nerves or other radiosensitive structures, it may change your treatment plan because this is an area of the body that does not tolerate radiation well. This could lead your doctor to consider surgery for meningioma as the primary means of tumor removal, minimizing the need for follow-up radiation therapy.
What’s Right for You
During the treatment planning process, your doctor will consider your individual health condition and the features of your meningioma to help determine which treatment option can yield the highest benefits with the lowest risks. If a procedure is determined to be too risky, your doctor will not recommend it as an option, whether that is because of your tumor location, complicating health conditions or any other factor.
At this point, you have a better understanding of why your doctor has made specific treatment recommendations. If you find you still have questions, be sure to follow up at your next appointment. It’s important you are comfortable with your upcoming treatment and your doctor will be glad to address any further concerns.