Excision Of Meningioma

Dr Roy Koh Kiok Miang
Consultant Neurosurgeon

What Is Meningioma?

Meningioma is a type of tumour that originates from the meninges, the membranous layers surrounding the brain and spinal cord. Meningiomas are commonly benign, but in rare cases, they can be malignant, indicating a more aggressive growth pattern and a higher risk of recurrence after treatment.

The exact cause of meningioma is poorly understood, but several factors are believed to contribute to its development. These include genetic mutations, exposure to radiation, and hormonal influences. Meningiomas are more frequently diagnosed in women than in men, suggesting a possible link to hormone levels, particularly progesterone.

Diagnosis of Meningioma

  • Magnetic Resonance Imaging (MRI)

MRI provides detailed images of the brain and spinal cord, allowing for the precise localisation of the tumour and assessment of its impact on adjacent structures.

  • Computed Tomography (CT) Scan

A CT scan can identify calcifications within the tumour, which are common in meningiomas, and assess the effects of the tumour on the skull.

In certain cases, a biopsy may be necessary to confirm the diagnosis of meningioma and determine its grade. A biopsy involves the removal of a small tissue sample from the tumour, which is then examined under a microscope.

Other tests may be conducted to evaluate the tumour’s effects on brain function or to identify potential complications. These can include:

  • Neurological function tests are conducted to assess vision, hearing, balance, and cognitive function.
  • Angiography is used to visualise the blood vessels supplying the tumour.

Indications for Surgical Excision

Surgical excision is considered the primary treatment for meningiomas, especially when the tumour is causing symptoms, growing, or is located in an area that affects neurological function.

Symptomatic Meningiomas

Surgery is recommended for meningiomas that cause symptoms such as headaches, seizures, visual disturbances, and cognitive or motor deficits.

Asymptomatic Meningiomas

Surgery may be advised for asymptomatic meningiomas if the tumour shows signs of growth on serial imaging studies. The potential for future growth and the development of symptoms may warrant removal.

Tumour Location and Accessibility

The tumour’s location significantly influences the decision to operate. Meningiomas located in areas where surgical access is feasible and safe may be candidates for excision.

Patient Health

Surgery may be less advisable for patients with significant health risks where the potential benefits do not outweigh the risks of surgical intervention.

Atypical and Malignant Meningiomas

Atypical and malignant meningiomas have a higher risk of recurrence and aggressive growth patterns, and they require surgical removal even if they are asymptomatic.

Surgical Techniques

The choice of surgical technique depends on the tumour’s size, location, and relationship to critical brain structures. These are the two primary approaches that are commonly used:

Craniotomy

A craniotomy is a surgical procedure that involves removing a portion of the skull to access the brain. This technique is often preferred for larger meningiomas or tumours in complex locations.

  • Procedure: The neurosurgeon makes an incision in the scalp and removes a piece of bone to expose the brain. The meningioma is then carefully separated from the surrounding brain tissue and removed.
  • Closure: Once the tumour is removed, the piece of bone is replaced and secured, and the scalp incision is closed.
  • Advantages: This approach provides direct access to the tumour, allowing for precise removal.
  • Considerations: Craniotomy can be associated with longer recovery times and a higher risk of complications than less invasive methods. Advances in surgical techniques and imaging technology have significantly improved outcomes.

Minimally Invasive Approaches

Minimally invasive techniques, such as endoscopic and keyhole surgeries, are increasingly used for meningiomas that are smaller and located in less complex areas.

  • Procedure: These approaches involve smaller incisions and using an endoscope or specialised surgical tools to remove the tumour through a small opening.
  • Advantages: Minimally invasive surgeries typically result in shorter hospital stays, less postoperative pain, quicker recovery, and smaller scars.
  • Considerations: These techniques may not be suitable for all meningiomas, particularly those large or intricately intertwined with vital brain structures.

Postoperative Care

Postoperative care following the excision of a meningioma is important to ensure a smooth recovery and to monitor for any complications.

Immediate Postoperative Period

  • Monitoring: Patients are closely monitored in a recovery room immediately after surgery. Vital signs, neurological status, and signs of complications such as bleeding or swelling are regularly assessed.
  • Pain Management: Pain and discomfort at the incision site are common after surgery. Effective pain management strategies, including medications, keep the patient comfortable.
  • Prevention of Complications: The administration of antibiotics to prevent infection and medications to reduce swelling around the brain may be initiated.

Hospital Stay

  • Duration: The length of the hospital stay can vary depending on the extent of the surgery, the patient’s response to the procedure, and any complications. A stay of several days to a week is common for most patients.
  • Physical and Occupational Therapy: Physical and occupational therapists work with the patient to enhance mobility, strength, and daily living skills after the surgery.

Discharge and Home Care

  • Discharge Planning: Before discharge, a comprehensive plan is developed to address the patient’s needs at home. This includes wound care instructions, medication management, and scheduling follow-up appointments.
  • Support at Home: Patients may require assistance with daily activities in the initial weeks following surgery. Family members should provide necessary support during this recovery phase.

Potential Risks

Surgical removal of a meningioma, while often necessary for the treatment of the tumour, carries some potential risks and complications.

  • Bleeding: As with any surgical procedure, there is a risk of bleeding during or after meningioma excision.
  • Infection: There is a risk of infection, though prophylactic antibiotics are often used to reduce this risk.
  • Swelling: Brain swelling can occur post-surgery, potentially affecting brain function. Medications to reduce swelling are commonly administered.
  • Neurological Deficits: Depending on the tumour’s location, surgery can result in temporary or permanent changes in sensation, movement, vision, or other neurological functions.
  • Seizures: Patients may experience seizures after surgery, which can usually be managed with medication.
  • Vascular Injury: Injury to blood vessels in the brain during surgery can lead to stroke or other serious outcomes.

Dr Roy Koh Kiok Miang

Consultant Neurosurgeon

Dr Roy Koh has expertise to manage a wide variety of neurosurgical and spinal problems. He was the first Neurosurgical Spine Consultant at KTPH and also performed Singapore’s first minimally invasive removal of a Spinal Tumor.

  • MBBS, National University of Singapore (NUS) in 2000
  • Basic Surgical Training in 2004
  • MRCS (Edin) and Master in Medicine(Surgery) in 2006
  • Neurosurgical Advanced Surgical training in 2008
  • Fellowship with Neurosurgical Department in Addenbrookes Hospital, Cambridge

Dr Koh has been active in pursuing his love for neurosurgery and spine surgery. He has also been an invited surgeon to places like India and visiting specialist surgeon for the Vietnamese Neurosurgical Congress in 2013, showcasing his new minimally invasive spine techniques to our neighbours.

Dr Koh is an Adjunct Assistant Professor in the Yong Loo Lin School of Medicine, where he is an MBBS examiner, and actively involved in training of the next generation of doctors.

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    Excision Of Meningioma in Singapore

    Frequently Asked
    Questions

    Can a meningioma come back after surgery?

    Meningiomas can recur after surgery, especially if the tumour is not completely removed or is an atypical or malignant meningioma. Regular follow-up imaging, such as MRI scans, is important for monitoring recurrence.

    Will I need further treatment after surgery?

    The need for additional treatment depends on the tumour’s characteristics and whether it was completely removed. In some cases, radiation therapy may be recommended after surgery, particularly for atypical or malignant meningiomas or if residual tumour remains.

    Can lifestyle changes reduce the risk of meningioma recurrence?

    There is no conclusive evidence that lifestyle changes can prevent meningioma recurrence. Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and avoiding exposure to known carcinogens, can improve overall health and may support brain health.