Recently we treated 3 adult male patients on the same day, all with meningiomas. Together they illustrate the fact that meningiomas are not always benign and slow growing, and when they occur in difficult positions it can make surgical treatment complex and risky.
The first patient (65 year old male) originally presented 5 years previously with left sided weakness. At that time a right parafalcine frontoparietal meningioma was diagnosed and resected. The histology was Atypical Meningioma. This is a more aggressive form, with a high chance of recurrence (see figure 1). His tumour did recur locally after about 1 year and was treated with radiotherapy. Unfortunately a large more distant recurrence occurred recently, causing more headaches and left sided weakness. Further surgery for this more frontal tumour was performed.
Although this tumour mass was resected without incident the extensive nature of the more posterior tumour makes it impossible to cure with surgery (see figure 2). Options with further progression are limited.
The second patient operated on that day was a 45 year old man who presented with a short history of left sided visual loss. An MRI showed a meningioma of the left anterior clinoid process, compressing the left optic nerve and encircling the left internal carotid artery (see figure 3). A complete resection was achieved and his vision recovered quickly.
The third patient operated on that day, was a 55 year old male who presented with right sided weakness and headaches. A very large tumour was seen on MRI with considerable mass effect (see figure 4). Again it was encircling the left internal carotid artery. Despite this, a complete resection was achieved with no complications.
Whilst a good outcome was achieved, these cases illustrate that to treat meningiomas appropriately, access to advanced imaging and intraoperative facilities is required. For optimal results, specialized brain tumour surgery training is ideal. This is available at BrizBrain & Spine.
By Prof David Walker – BMedSc, MBBS, PhD, FRACS