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Management of Meningiomas

Management of Meningiomas. DIAGNOSTIC TOOLS. MRI Dural tail, edema CT SCAN : Hyperostosis, intratumoral calcifications ANGIOGRAPHY: embolization is a consideration tumor blush. DIAGNOSTIC TOOLS. HISTOLOGY Globular, well demarcated Wide dural attachment

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Management of Meningiomas

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  1. Management of Meningiomas

  2. DIAGNOSTIC TOOLS • MRI • Dural tail, edema • CT SCAN: • Hyperostosis, intratumoral calcifications • ANGIOGRAPHY: • embolization is a consideration • tumor blush

  3. DIAGNOSTIC TOOLS • HISTOLOGY • Globular, well demarcated • Wide dural attachment • Invaginated into underlying brain with no invasion • Cut surface: translucent pale, homogenously reddish brown, • Gritty • Meningioma en plaque: occur as sheet- like extension that covers dura; does not invaginate parenchyma

  4. IMMUNOCHEMISTRY (+) Epithelial membrane antigen (-) anti- Leu 7 antibodies (+) progesterone, somatostatin receptors

  5. TREATMENT OPTIONS • SURGERY • Objective: total removal of the meningioma, dural attachment and bone involved with the tumor • Priority: preserve and improve neurological function • RADIOTHERAPY • Indications: • Residual tumor left at operation • Recurrence • Tumors could not be treated surgically • Malignant histology

  6. OBSERVATION • Asymptomatic patients with little or no edema in the adjacent brain areas • Patients with mild or minimal symptoms • Older patients with seizure or very slowly progressing symptoms • Patients in whom treatment carries a significant risk

  7. FOLLOW- UP • Multidisciplinary approach for patients with disabilities (e.g. diplopia, dysphasia, dysphagia) • Regular follow-up with enhanced MRI to check for possible recurrences • Patients who are discharged home with antiepileptic agents should be monitored

  8. OPERATIVE MEASURES • Steroids for at least 48 hours; longer with significant brain edema; postoperatively, tapered off over 5 days or longer • Intravenous antibiotics before operation; 24 hours after the procedure • Anti- convulsant medications (phenytoin, carbamazepine, valproic acid) for supratentorial operations

  9. TYPES OF RADIATION THERAPY • EXTERNAL- BEAM RADIATION THERAPY • 5000- 5500 cGy • Daily fractions: 180-200 cGy over 5-6 weeks • Particular care near optic nerves and brainstem • Radiosurgery: Co- gamma unit • Dose delivered to margin of tumor : 15-18 Gy • Proximal to optic nerves and chiasm: 9 Gy

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