Doctors Lounge - Oncology Answers
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Forum Name: Brain Tumors
|kammi - Sun Jan 29, 2006 9:07 pm||
I am a 57 yr old female. I have previously been diagnosed with SLE, RA, sjogrens disease and osteoarthritis. I have had a hysterectomy, knee replacement, galbladder removal and surgery to repair a foot which was injured in an accident.
Family history includes:
Mother: breast cancer, osteoporosis, diminished lung capacity, high blood pressure, acid reflux, asthma
Father: deceased (Alzheimers Disease), skin cancer
Grandmother: stomach cancer, RA, high blood pressure
Grandfather: skin cancer
Sister: Multiple Sclerosis, Grave's Disease
Sister: Pituitary tumor (disappeared), asthma
Predinsone, Methotrexate, Effexor, Ambian, Aciphex, Placqunil, Glucosamine/Chondroitin, Fish Oil, One-a-day vitamin, Caltrate-600, Folic Acid, Imitrex
A 2 cm meningioma with "a tail" just showed up (Jan. 9, 2006) on an MRI taken of my head. I was referred to a neurosurgeon who said it is located awfully close to my optic nerve so he is therefore skeptical about using Gamma Knife as a viable procedure to remove it. He sent me to a neuro-opthamologist and took my films to a "Gamma Knife convention" meeting (I believe this is a group who attended a Gamma Knife convention.) 3 of the 4 "gamma knife convention" group of neurosurgeons said gamma knife was out of the question...as did the neuro-opthamologis. They say it is surgery or wait/watch. The danger of waiting and watching is the chance it will grow into the optic nerve or close enough to make the surgery very risky as far as damage to the optic nerve.
I am wondering where is the best place to go to get treatment for this; or get a second opinion.
I am also wondering if something like steroids could make it reduce in size or go away. I have been on varying amounts of steroids for 3 years and on methotrexate for 1.5 years (which I thought was a possibility for treatment of meningiomas).
I have Lupus and had been having, what I thought was, migraine headaches which were increasing in number and intensity. I ended up in the hospital with one a couple of weeks ago. I was on Topamax, Imitrex and pain medicine..not to mention the other meds I take for Lupus (Methotrexate, Prednisone, Plaqunil, etc.) Both the neuro-surgeon AND the neuro-opthamologist said they didn't think the meningioma was the cause of my headaches. Yet when my rheumatologist increased my steroids this week from 1.5 to 2 mg per day, I already feel some relief from the tingling on the side of my head and I have not have a bad headache since then. The neuro surgeon thinks it may be best to do a craniotomy. I am NOT wanting to do the surgery and had hoped something like the gamma knife, the cyber knife or FSR might work. Where is the best place to take care of and cure something like this?
All of my eye tests checked out fine. The headaches, however, are debilitating and occuring every other day until I increased the steroids. Would relief from steroid indicate swelling around the tumor? I am very concerned about the right path to take. I don't want my vision impaired by either neglect or gamma knife/surgery. I also would like relief from the "tumor headaches"
What do you think?
|Dr. Safaa Mahmoud - Fri Jul 14, 2006 8:43 am||
In treatment of meningioma,
Total resection is still the primary curative approach for meningioma. Complete resection is the goal in surgical treatment however, being slowly growing benign tumor, less invasive approaches are considered in certain type of patients .
When the risk of surgical removal outweigh the advantages of complete resection, alternative therapy like Radiotherapy is considered. Radio-surgery is a highly focal, closed-skull external irradiation in which an imaging-compatible stereotactic device for precise target localization is used to deliver the radiotherapy dose.
Selection of patients who are candidate for radiosurgery is very important. In general, eligible Patients with meningiomas are those with Well defined lesions by CT or MRI, of tumor size less than 3.5 cm in average diameter and located at least 5 mm from the optic chiasm or nerve.
You have mentioned that the lesion is very close to the optic nerve. That is why your consultant did not encourage Radiosurgery using the Gamma knife due to the high risk of optic nerve injury.
I am not a specialist in this area however, , Observation according to your MRI results is not a very safe approach, again due to high possibility of optic nerve compression.
An expert neurosurgeon would be more helpful in giving you detailed in formations about the best approach in your condition and how to be followed up.
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