Description of the problem:
My dad is 48 years old and two months ago he had dizziness and blurring of the eyes, and was examined for a "right trapezoidal meningioma". The size of the tumor is 4*4cm, but the dizziness and blurriness have disappeared. But now the dizziness and blurriness have disappeared. I only have muscle pain when I bend my right arm, and I have muscle pain when I stretch my arm when I wake up at night. The rest of my condition is fine. Is it because of the pressure of the right trapezoidal meningioma? Do you need urgent treatment now? If not, how long will it take? Is there any medication that can be used to suppress the growth of the meningioma? If yes, can you introduce a medicine? What is the best and economical way to treat my father's meningioma?
Ans:
Hello, what is the size of the diagnosed tumor? If the tumor is the size of a fist, then the patient's tumor is relatively large. Generally speaking, meningiomas with a diameter of 5cm are not considered suitable for radiation therapy and should be treated with surgery as the first choice. Surgery should be the first choice. Of course, this also needs to be considered in conjunction with the patient's physical condition. If the doctor suggests surgery, then you can go to a more authoritative hospital for surgery, so as not to miss the opportunity. The cost of surgery is high, about 40,000 to 100,000 dollars.
The incidence of meningioma in the population is 2/100,000, and it can occur at any age, and is more common in middle-aged people, and slightly more common in women than in men. The most common sites of meningiomas are: 89% of supratentorial, 11% of infratentorial; the cerebral convexity, sagittal sinus, and parafalcaneal area, followed by the skull base, and intracerebral ventricles are less common. The incidence of meningiomas has increased significantly in recent years, especially in the elderly. Many asymptomatic meningiomas are detected incidentally, slow-growing and have a long course. Early symptoms of meningioma appear in 2.5 years on average, and in a few patients it can be as long as 6 years, and patients often have headache and epilepsy as the first symptoms. According to the different parts of the tumor, vision, visual field, olfactory or auditory disorder and limb movement disorder can also appear. In elderly patients, epilepsy is the first symptom.
Meningiomas are mostly benign, malignant or malignant changes account for 1-2%. Most of them are substantial, with envelope and rich blood flow; the tumor is often larger and deeper, adjacent to some important blood vessels and nerves, which makes it difficult to deal with. Clinical manifestations are dominated by chronic progressive intracranial pressure hyperintensities, and local source symptoms may occur. Due to the significant advances in anesthesia and surgical equipment and techniques, the success rate of meningioma treatment has been greatly improved. However, due to the nature of the tumor and anatomical features, the management of certain meningiomas is still difficult and requires early diagnosis and treatment. Death from brain herniation occurs in advanced stages. Surgical resection is the best treatment for meningiomas. With the increasing popularity of CT examination, meningiomas can be diagnosed and treated early.
Classification of meningiomas
WHO classifies meningiomas into three types according to the degree of active tumor proliferation, invasiveness and other biological behaviors: typical or benign meningiomas, accounting for 88-94%; atypical meningiomas, accounting for 5-7%; and mesenchymal type, i.e., malignant meningiomas, accounting for only 1-2%.
Clinical manifestations of meningioma
1. Meningiomas are benign tumors with slow growth and long course. Because of the swelling growth of the tumor, patients often have headache and epilepsy as the first symptom.
2. Symptoms of increased intracranial pressure are not obvious. Many patients only have mild headache, and even the meningioma is found by CT scan by chance.
3. The effect of meningioma on the skull: meningioma close to the skull can often cause bone changes, manifested as thinning of the bone plate under pressure, or destruction of the bone plate, or even erosion of the bone plate to the capitellar tendon membrane, and localized bulging of the scalp.
4. For the same patient, it is best to conduct CT and MRI comparative analysis at the same time, in order to get a more correct qualitative diagnosis.
Specific symptoms:
Headache after waking up: headache caused by brain tumor is the worst when waking up from a sound sleep, and gradually relieved during the day. The pain is mostly throbbing dull pain or swelling pain, paroxysmal or persistent pain. In severe cases, it can be accompanied by nausea and vomiting, and the pain is relieved after vomiting. About 90% of patients present with this syndrome.
Ocular symptoms: gradual delay in vision, or even complete blindness; double vision; protrusion of one side of the eye, and in severe cases, burst closure incomplete.
Unilateral deafness: if middle-aged people have no history of otitis media and trauma, only one side of the progressive hearing loss, or accompanied by tinnitus on the same side, most of them are caused by brain tumor compression of the auditory nerve.
Other manifestations: ① late-onset epilepsy (epilepsy occurs after middle age); ② hemiplegia; ③ limb enlargement; ④ eyebrow arch and jaw protrusion, ugly appearance. Children may develop into giants; ⑤ amenorrhea and lactation in non-pregnant women of childbearing age are often the first symptoms of pituitary adenomas; ⑥ in male cases, it is manifested as impotence, *** and beard loss, thickening of subcutaneous fat, and other signs of feminization.
The special clinical manifestations of meningiomas are different according to different parts of the brain, which are summarized as follows:
Cerebral convex meningioma:
The history of the disease is generally longer, and the main manifestations of the disease are headache of different degrees, mental disorders, limb movement disorders, and changes in visual acuity and field of vision, and the symptom of elevated cranial pressure can be seen in about 60% of the patients after half a year, and some of the patients can have partial epilepsy, facial and hand convulsions, and grand mal seizures. Face and hand convulsions, grand mal seizures are uncommon.
Parasagittal sinus meningioma:
The tumor grows slowly, and when the patient develops symptoms, the tumor is very large. Epilepsy is the first symptom of the disease, with partial or grand mal seizures, and mental disorders manifested as dementia, affective indifference, or euphoria, and the patient develops a change in personality.
Sphincteric crest meningioma:
The tumor originates from the anterior bed protrusion, which may present with loss of vision or even blindness; invasion to the orbit or supraorbital, which may present with protrusion of the eyeballs, oculomotor disorders, and pupil dilation; epilepsy, psychiatric symptoms, and olfactory disorders.
Saddle node meningioma: visual field disorder, more than 80% of patients with visual impairment as the first symptom; headache, a small number of patients can appear drowsiness, memory loss, anxiety and other psychiatric symptoms; some patients can appear endocrine dysfunction, such as *** Decrease, impotence, amenorrhea, etc.; there are also patients with loss of smell, epilepsy, kinetic nerve paralysis as the first symptom of the consultation.
Meningioma:
The motor disorders start from the feet, gradually to the lower limbs, followed by upper limb muscular disorders, and finally spread to the head and face. If the tumor grows to both sides, there may be bilateral limb muscular weakness and accompanied by urinary disorders, epilepsy, and symptoms of increased intracranial pressure.
Olfactory sulcus meningioma:
Early symptoms include gradual loss of sense of smell, increased intracranial pressure may cause visual impairment, and when the tumor affects the function of frontal lobe, there may be euphoria, hallucination, delusion, retardation, mental apathy, and epilepsy in a few patients.
Bridge cerebellar angle meningioma:
This part of the tumor to the auditory neuroma is common, accounting for 70-80% meningioma, accounting for 6-8%, cholesteatoma 4-5%, clinical manifestations of hearing loss, tinnitus, facial numbness, hyperalgesia, trigeminal neurinoma, unsteady walking, coarse horizontal tremor, the affected side of the **** jizygous disorder.
Igneous-slope meningioma:
It often presents with a headache, which often goes unnoticed, and symptoms of III-X cranial nerve damage are evident.
Intracerebroventricular meningioma:
Because it grows within the ventricles of the brain, early neurological impairment is not obvious, and the tumor is usually large when it is diagnosed, often presenting with headache, visual *** edema, epilepsy, isotropic hemianopsia, and hemiparesis of the contralateral limb.
Meningioma of the middle cranial fossa:
Trigeminal neuralgia, ocular motility disorders, ptosis, diplopia, diplopia, loss of mental faculties, synoptic hemianopsia.
Cerebellar tegmental meningioma:
Gross horizontal tremor and ***** dysmetria on the affected side, visual field disturbances, etc.
Parasagittal meningioma of the sponge sinus:
Manifestations include headache, altered visual field, paralysis of the ocular muscles, and pain in the area of distribution of one or two branches of the trigeminal nerve.
Occipital foramen magnum meningioma:
Early manifestations include neck pain, numbness of the hands and upper extremities, which can be easily misdiagnosed.
Orbital and cranio-orbital communicating meningiomas:
Projection of the eyeballs, ocular motility disorders, and loss of vision.
Diagnosis of meningioma
Diagnosis is based on:
1. Long course, slow onset, chronic progressive headache, mental abnormality, and limited epilepsy; gradually localization symptoms may appear. In the later stage, obvious symptoms of increased intracranial pressure and typical localization signs of meningiomas in various parts of the brain may appear.
2. Head CT: the lesion is uniformly high or high density, with clear boundary, wide base, more obvious tumor image on enhanced scan, and compression of ventricular system.
3. MRI of the head: most meningiomas are low signal (T1-weighted) and high or equal signal (T2-weighted), and the signal is uniformly increased after injection of Gd-DTPA contrast agent; there is a low-signal ring or band between the tumor and the brain tissues; it is accompanied by peri-tumor edema, which clearly shows the relationship between the tumor and blood vessels and venous sinuses.
4. Angiography: In addition to the displacement of normal blood vessels, the tumor is usually seen as a "stained" image, which can not only locate but also characterize the tumor.
Meningioma treatment
Microsurgery is the treatment of choice for meningiomas.
Simpson classification of the degree of resection of meningiomas
Grade I Total resection of the tumor and removal of the tumor-affected dura mater and skull
Grade II Total resection of the tumor and laser or electrocautery of the tumor-attached dura mater
Grade III Total resection of the tumor, with no treatment of the tumor-attached dura mater
Grade IV Partial resection of the tumor
Grade V Tumor decompression or biopsy alone
In recent years, many scholars have proposed the concept of Simpson's grade 0 resection through clinical and basic observation, which is to resect the 2 cm of normal dura surrounding the affected dura. The main reasons for this are, 1 the potential infiltration of meningioma cells, 2 the multicenter origin of meningiomas, and 3 the clinical finding that grade I resected meningiomas can also recur. Several clinical studies have confirmed that grade 0 resection can reduce the recurrence of meningiomas.
Prognosis of meningiomas
The prognosis of meningiomas depends mainly on the location, resectability, and type of lesion. Tumors of the same histologic type can be completely resected in the convexity of the brain and have a better prognosis than meningiomas of the skull base involving the cavernous sinus. Using the WHO classification, the recurrence rates of different types are significantly different, with the 5-year postoperative recurrence rate of typical benign tumors being only 3-7%, the recurrence rate of atypical tumors being about 1/3, and the recurrence rate of mesenchymal tumors being as high as 75%. With the advancement of microsurgical techniques, the prognosis of meningiomas has been improving.
Choice of treatment
1. Microsurgery: Like other intracranial tumors, surgical resection of meningioma is the most effective treatment. With the development of microsurgery technology, the improvement and popularization of surgical instruments such as bipolar electrocoagulation, ultrasonic suction, and laser, the surgical effect of meningioma has been improved continuously, and most of the patients can be cured.
Surgical principles:
1) *** : Depending on the location of the tumor, the lateral, supine, and prone positions are often used ***.
2) Incision: Advances in imaging and the advent of navigation techniques have made the localization of the tumor very precise, so the key to the design of the incision is to locate the tumor just in the center of the bone window.
3)Application of surgical microscope: Separation of the tumor under the surgical microscope allows for a more detailed operation and maximizes the protection of brain tissue and important neurovascularity.
4)For blood-rich tumors, the supplying artery can be embolized preoperatively or the blood vessels supplying the tumor can be ligated intraoperatively.
5) The dura mater and skull bone eroded by the tumor should be removed together to prevent postoperative recurrence. The dural sinus that has been confirmed to be occluded by imaging can also be resected. The dura mater and skull should be repaired with fascia or artificial materials.
6) Postoperative treatment: control of intracranial pressure, antiepileptic treatment, attention to the prevention of cerebrospinal fluid ear leakage, nasal leakage.
2. Radiotherapy:
For meningiomas that cannot be completely excised and a few malignant meningiomas, radiotherapy is needed after surgical resection. Malignant meningiomas and vascularized ependymal meningiomas are sensitive to radiotherapy, and the effect is certain. Comprehensive literature, the indications for gamma knife treatment of meningiomas include: ① meningiomas growing at the base of the skull or deep inside the brain, which are difficult to be completely resected by surgery; ② average diameter of the tumor is less than 30mm; ③ tumor margins must be more than 5mm away from optic nerves, optic crossings, and optic bundles; ④ multiple meningiomas, residual or recurrent meningiomas after surgery; ⑤ patients of advanced age (>70 years old), and the tumor's persistent growth is confirmed by the imaging data; ⑥ patients with heart, lung, kidney, blood system diseases, and other diseases. Patients with heart, lung, kidney, blood system diseases or diabetes, etc., who have contraindications to surgery or cannot tolerate surgery.
3. Chinese and western medical treatment
Western medical treatment
Chemotherapy: Because most of the drugs are not easy to cross the blood-brain barrier, and most of the tumors are not sensitive to chemotherapy. As a result, the choice of drugs is very limited. Commonly used anti-brain tumor drugs include benzathine mustard (BC-NU), chloroethylcyclohexane nitrosourea (CCNU).
Surgical treatment: benign brain tumors can be cured and not recur if they are completely removed. Long in the frontal, temporal or occipital glioma, line lobotomy scale can also achieve good results. If the swelling cannot be completely removed, it can be partially removed and decompression surgery can be performed.
Radiation therapy: postoperative radiation therapy can be performed to delay recurrence. The source of radiation is 60Co-gamma ray, gas pedal high-energy X-ray, electron beam and so on.
Other treatments: it is not certain whether hormone therapy is effective in slowing down the growth of tumor, but it is a promising method for recurrent meningioma.
Traditional Chinese medicine
Single prescription: (also known as snake six valley, mushroom taro) 30 grams, fried for 3 hours, divided into 3 times oral, 1 dose per day.
External treatment
① Fresh golden scissors grass root appropriate amount, the medicine will be washed, put a small amount of salt **** mashed, applied to the head of the tumor affected area, 24-36 hours after the removal. Generally, the compress 1 time.
② snail, alum, appropriate amount. The snail to cover, with alum pounded as mud, external compresses on the affected area.
4, precautions
Actively care for the patient, to create a good environment to stabilize the patient's mood, do not disclose the condition, so as not to aggravate the condition of the patient due to the back of the ideological burden. Diet is based on easily digestible semi-liquid, rich in protein, and more vegetables to keep the bowels open. Closely observe the change of condition, headache, nausea, vomiting and other symptoms should be symptomatic treatment.
5. Prevention
Pay attention to dietary hygiene, avoid benzopyrene, nitrosamines and other carcinogenic substances into the body. Pay attention to personal hygiene, exercise, enhance resistance, and prevent viral infections. Avoid traumatic brain injury, and when traumatic brain injury occurs, it should be cured in time. People who have already suffered from intracranial tumor should not have children again. In daily life, you should consume more yellow-green vegetables and fruits, such as carrot, pumpkin, tomato, lettuce, oil cabbage, spinach, jujube, banana, apple, mango and so on.
The above is for your reference, I don't know which city you are in, please try to be in an authoritative hospital for consultation and treatment.
I wish patients a speedy recovery.
I wish the patient a speedy recovery.