A meningioma is usually a benign tumour that arises from the lining of the brain. This means that the tumour is sitting between the brain tissue and the skull rather than being within the substance of the brain. The tumour causes problems by growing into and compressing the brain and so the symptoms are dependant on which part of the brain the tumour is compressing and what function is affected. Meningioma removal whilst preserving normal brain function requires careful microsurgical technique particularly where the tumour is on the base of the skull surrounded by nerves and arteries with critical function. Removal of these tumours also requires advanced techniques and subspecialty training with the best results being achieved in teams where, the surgery is commonly performed, by experts.
Indications for surgery: Symptoms or pressure effects from a large or growing tumour.
Alternatives to surgery: For smaller tumour with no symptoms or minimal pressure effects observation and repeated scans may be suitable. For smaller but growing tumours either surgery or possibly radiotherapy are treatment options. For larger compressive tumours surgery may be the only treatment option.
Benefits of surgery: Definite diagnosis, relief of pressure effects on surrounding brain structures, removal of tumour.
Risks of surgery: The risks of this surgery depend largely on the location of the tumour and the parts of the brain that are compressed by the tumour. Meningiomas of the skull base require subspecialist expertise to remove the tumours safely and reduce the risks of damaging adjacent nerves arteries and brain tissues. Treatment of larger skull base tumours requires some of the most technically demanding, difficult surgery possible with even the most modern techniques and consequently is associated with serious and real risks to life and function. Risks include death, stroke and serious disability / dependence. Working in expert specialist teams reduces these risks considerably. Other risks of surgery include weakness, numbness, personality changes, changes to speech, understanding or memory, seizures, loss of smell, vision, hearing, double vision, facial feeling and or movement and swallowing or speech disturbance. These risks are more or less likely depending on the exact location and size of you tumour. All meningioma operations have a risk of bleeding, CSF leakage, wound infection, pain or numbness and headaches. All operations have a risk of complications related to anaesthesia and general medical complications such as blood clots or infections.
I will go through the specific risks and there likelihood depending on the location and size of the tumour before an operation.
After surgery to remove a meningioma patients are closely monitored in a neurosurgical high dependency or intensive care environment. Close attention is kept on neurological and cardiovascular parameters allowing skilled staff to react if post-operative complications were to occur. Depending on the location of tumour removal patients are mobilized and recover in an individual fashion. Typical inpatient stay following this surgery is between 2 days and 2 weeks during which specialist physiotherapists and doctors will attend to your recovery.
After discharge patients should refrain from driving and other activities should also be modified. Depending on function, walking is usually encouraged. Don’t be surprised to feel tired and need to sleep more following surgery this is usual. However, patients should be easily rousable from sleep. If not easily rousable then an emergency ambulance should be called.
Wounds should be kept clean and dry with dressings intact for 10 days after surgery. If the dressings become wet or soaked they should be immediately changed. You should see your GP or practice nurse 10 days after surgery for a wound review following which any stitches can be removed and the wound can be cleaned gently and dabbed dry.
I will see you 6 weeks after surgery in the outpatient clinic but if you have concerns either contact me or see your GP, or, if the matter is urgent present to the Royal Melbourne Hospital emergency department for review or call an emergency ambulance.
You may be sent home on either anti-seizure medications or steroids. Anti-seizure medications are important and should not be suddenly stopped. You should continue these unless advised specifically otherwise. Steroids are important but should usually only be taken for short periods of time or they can cause complications. You should be advised how to wean off the steroids and should not take them for more than two weeks post operatively unless specifically advised to do so. It is best to check with me or the hospital if you have medication related concerns.