Meningiomas are tumors that most frequently arise from the covering of the brain (dura mater). The vast majority of meningiomas are not cancerous. While most meningiomas are benign, they can cause neurologic symptoms due compression of adjacent brain and spinal cord structures. Some symptoms can include: seizures, weakness, speech difficulty, and balance/coordination difficulties. At Dallas, Brain, Spine, and Skull Base Surgery (DBS) we believe meningiomas warrant treatment if there are neurologic symptoms referable to the meningioma, the meningioma has shown growth on consecutive imaging studies, or if the meningioma is causing irritation of the adjacent brain tissue as seen on imaging.
There is no medical treatment that effectively removes meningiomas. The two common treatments for meningiomas are surgical resection and focused-beam radiation (stereotactic radiosurgery). These two treatment modalities have benefits and risks associated with them. Open surgical removal stands the best chance of complete removal of the tumor and has the lowest chance of tumor recurrence. However, surgery involves an incision, bony skull removal/replacement, and manipulation of neurologic structures. This exposes the patient to potential infection, neurologic injury, and seizures. While the rates of surgical complications are generally low, their severity can be daunting to consider for the prospective patient. At DBS, we have developed minimally invasive approaches for meningioma resection that dramatically reduce incision size, bone removal, and risk of neurologic injury. Through our minimally invasive approaches we are frequently able to remove the complete tumor tumors completely before we visualize normal neurologic structures. This serves to protect those structures throughout the case and limits both intentional and unintentional contact with critical structures. These minimally invasive approaches result in faster recovery times and significantly reduced complication rates.
Sometimes a meningioma occurs in a setting where open surgical resection poses too much risk to the patient, because they have either had prior surgery or the tumor is in a location where the risk of neurologic injury is too high. In cases like this, we employ the use of stereotactic radiosurgery (SRS). More traditional radiation treatments involve exposing patients to a single source of radiation. This results in the normal tissue next to the tumor receiving nearly as much radiation as the tumor itself. Using SRS, we introduce multiple low energy beams of radiation which pass through the body at different angles. All the beams then converge inside the tumor. This allows us to reach high doses of radiation within the tumor while significantly reducing the radiation to adjacent normal tissue. The neurosurgeons at DBS have partnered with radiation oncologists to offer SRS for brain and spine tumor treatments, including meningiomas.