Meningiomas are brain tumors, usually benign, that starts in the cells that cover the surface of the brain. They grow in the region of the cerebral hemispheres or at the level of the cranial base (meningioma of the cavernous sinus), and are characterized by rather slow growth and in most cases without infiltration of the brain tissue that surrounds them.
Among the first manifestations of meningioma, is epilepsy and alterations of behavior. Depending on the precise location of the meningioma, there may be difficulty speaking or moving an arm or leg. The headache which is the most common symptom for many other brain diseases, in this case, is rather rare. In some cases, discoloration of the scalp may also occur at the site of the meningioma, which takes the form of the meningioma itself. They are rounded and have a diameter of a few centimeters.
Often the diagnosis of meningioma occurs in a completely random manner when tests are prescribed such as MRI or CT scan to check other ongoing problems (for example for a history of headache or a head injury). This happens because in 70% of the cases the meningiomas are asymptomatic.
Once the diagnosis of meningioma has been ascertained, the neurosurgeon can evaluate different treatment options that mainly depend on the nature of the pathology.
The first therapeutic indication is usually represented by the surgical intervention that allows the total or partial removal of the tumor. In the case of meningiomas of the skull base, and in particular of the cavernous sinus, the treatment of stereotactic radiosurgery with Gamma Knife is beneficial, which allows excellent control of tumor growth with very low risks. Radiation therapy, on the other hand, is indicated in the presence of an aggressive meningioma or as a complement to surgery.
Gamma Knife radiosurgery is a technique for intracranial stereotactic radiosurgery. It can be useful for intervening on primitive brain tumors, such as meningiomas. Treatment with Gamma Knife allows targeting the meningioma with a beam of radiation.
The patient will be slightly sedated, then the stereotaxic helmet will be applied to him with local anesthesia. He will be subjected to MRI tests of the brain with gadolinium. These images allow the specialist to plan the treatment. Once the plan is completed, the patient will be lying down with the stereotaxic helmet attached to the Gamma Knife couch. The procedure can last from one to six hours, depending on the patient’s needs and the target to be irradiated.
The Gamma Knife treatment is a minimally invasive procedure, takes place in a single session and is free of pain and surgical incisions. The process is almost always outpatient, and the discharge of the patient usually takes place the same day.
The procedure is not painful, the patient may experience pain only when positioning the four small metal pins to stabilize the helmet. During the actual treatment, the patient will initially perceive slight movements of adaptation of the head to the machine, but will not feel either pain or noise.
The risks associated with this procedure can be neurological disorders, stroke, epileptic seizures, pain following treatment in a minute number of people.
Patients with meningiomas that do not exceed 3.5 cm in diameter may be treated.
Follow up
The results of the procedure are not immediate. The patient will be informed about the checks to be carried out at the time of discharge.
The effect of radiation occurs after weeks and/or months. Sometimes the irradiation with Gamma Knife may not be sufficient to solve the problem, and the neoplasm could continue to grow. Therefore, further treatments may be necessary, either Gamma Knife or craniotomy surgery.
Gamma Knife surgery is done at many hospitals in India such as PGIMER in Chandigarh and Hinduja Hospital in Bangalore. The most well-known center is of course at NIMHANS Bangalore. The cost ranges from INR 1 lakh to 2 lakhs per session or cycle or USD 1,400 to 1,800. If craniotomy is required, that is about the same cost as brain tumor operations and ranges between INR 3 lakhs and 5 lakhs or USD 4,200 and 7,000.
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