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Dr. F
Dr. F, Board Certified MD
Category: Neurology
Satisfied Customers: 266
Experience:  Neurosurgeon with more than 20 years experience in practice and teaching.
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I have a temporal lobe meningioma aprox. 2cm x 3cm with no

Customer Question

I have a temporal lobe meningioma aprox. 2cm x 3cm with no surrounding edema. Can this be removed endoscopically? or is traditional surgery better. Does it need to be removed? Which Center is the best in the USA? Have considered Hopkins & Barrows out of Phoenix.
Submitted: 4 years ago.
Category: Neurology
Expert:  Dr. F replied 4 years ago.
Chat Conversation Started
Dr. F :

welcome, I am a board certified neurosurgeon who would be glad to help

Dr. F :

there are good resources in the Midwest,

Dr. F :

is your lesion right or left temporal lobe, and are you right or left handed?

Dr. F :

Dear Ophthalmologist, As you are off line, and I must leave the forum, I am going to make this into a Q A , so that we may continue. I hope to resume helping in the near future.

Expert:  Dr. F replied 4 years ago.
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Customer: replied 4 years ago.
Right temporal lobe. Right Handed. I live in Kansas City at this time. I also developed an Essential tremor, left greater than right and have chosen to stop operating at this time. I have sold my laser center and would like to work again as a Medical Ophthalmologist or teach.

I have read about recurrence of the meningioma and wondered what percentage that might be. Vainly, I am concerned about the craniotomy because I have been told that there could be temporalis muscle atrophy post-op. Also, they say they close with staples. Is that standard? Would there be better cosmetic results with sutures?

I have heard of "non-invasive microsurgical techniques" but am concerned that they may miss some of the tumor without good exposure.

Thank you.. I have to go out this morning but will be home later today. Thanks for your help. No rush. I have heard that Barnes in St. Louis also has a good neurosurgical unit.
Customer: replied 4 years ago.
Good afternoon.

Good thing that I am not a neuroradiologist. I read my MRI from yesterday and compared it with my last MRI 10/17/07 and thought it had grown when I measured it on my computer. The report from the same neuroradiolgist of my previous MRIs read it this morning and states "unchanged".

That is a long time between MRIs but like many physicians I am the last to take my advice.

Still would like your answer or comments and will pay you promptly. Obviously, I have chosen a conservative path of observation over surgery for a number of years primarily out of fear of complications with the hope that there will be continued to be no growth. Prior MRIs from 06 were also the same.

My Neurologist locally will also get copies of the MRIs to confirm that comparable alignment and segment depth were used.

All the best...jeff
Expert:  Jack Scariano Jr replied 4 years ago.

Dear Eye MD. I am sorry about your lesion, it certainly can affect your skills. Dr. F is a fine Neurosurgeon, but I am not sure if she does endoscopic tumor surgery. I have had a endoscopic robot prostotectomy 2 weeks ago, and I am already back seeing patients.

 

I live and work in Knoxville Tennessee.

In Cincinnati ( 3hrs away)

about 20 years ago skull base surgery was born for CN V treatment for trigeminal neurolalagia . The surgeon, Dr May field who did the work, has since passed on. However being 3 hrs away I sent many patients there. with great results.

The may field clinic had remained one of the top centers in the US for Skull based and minimally invasive Neurosurgery. I recently had a 26y/o female with a benign clivis tumor which he did without any neurological residual. I understand that he is one of the top endoscopic NS in the world.

 

His link is: http://www.mayfieldclinic.com/MC_bios/Bio_Theod.htm.

His name isXXXXX MD.

 

He is not foreign but is an American with Greek ancestry. Great guy. Excellent national reputation. MIT trained plus top medical schools and fellowships.

 

I would give him a call and discuss your case. He will probably want to see the old and recent MRI's on CD. I am sure if he can help you, this is one of the top MD in the world to do endoscopic.

 

Hope this helps,

Good luck.

 

Dr.S Board Certified Neurologist

Expert:  Dr. F replied 4 years ago.

Dear Dr. Jeff,

 

It is true, I am not an endoscopic surgeon, but I do know the field and have some friends. I will only be able to partially answer your questions now, but will be back later on.

As we say, about your reinterpretation of the scan, sometimes time can clarify

 

More Answers...your statements followed by my responses

By the way, a lack of edema around the tumor is a good sign for slow or no growth

 

I have a temporal lobe meningioma aprox. 2cm x 3cm with no surrounding edema. Can this be removed endoscopically?

That is a relatively large tumor, and probably could not be done by an endoscope alone

 

or is traditional surgery better. Does it need to be removed? Which Center is the best in the USA? Have considered Hopkins & Barrows out of Phoenix.

 

You are looking for a skull based expert. Dr. Speztler is one of the best, XXXXX XXXXX don't have to go all that far. there is a skull base surgeon in KC, and a major center in STL at St Louis University

 

Right temporal lobe. Right Handed. I live in Kansas City

 

Vainly, I am concerned about the craniotomy because I have been told that there could be temporalis muscle atrophy post-op. Also, they say they close with staples. Is that standard? Would there be better cosmetic results with sutures?

 

Cosmesis can be OK with staples, and fine suture is usually used in the facial are, for best cosmesis. Check with the surgeon. Temporal muscle atropy does happen, and will be a concern, however ther are techniques and fill ins to lessen the risk and repair

 

More to follow, sorry, have a must do Photo thing and lost time keeping track of the situation at Johns Hopkins

Dr. F, Board Certified MD
Category: Neurology
Satisfied Customers: 266
Experience: Neurosurgeon with more than 20 years experience in practice and teaching.
Dr. F and other Neurology Specialists are ready to help you
Expert:  Dr. F replied 4 years ago.

...to continue, sorry it has taken so long to get back to you.

 

 

I have heard of "non-invasive microsurgical techniques" but am concerned that they may miss some of the tumor without good exposure. Thank you.. I have to go out this morning but will be home later today. Thanks for your help. No rush. I have heard that Barnes in St. Louis also has a good neurosurgical unit.

 

Microsurgical technique is the standard, non invasive is not usually part of the equation. The guiding principal of skull based surgery is exposure by removing bone with minimal brain retraction, and especially in someone as young as you, total resection as safely possible would be the goal.

The fact that it is on your non-dominant side is surely in your favor. It is hard to fault the team at Barnes; I have taken my family there, but the cerebro-vascular and skull base group at St Louis University also has a good reputation

 

Good afternoon. Good thing that I am not a neuroradiologist. I read my MRI from yesterday and compared it with my last MRI 10/17/07 and thought it had grown when I measured it on my computer. The report from the same neuroradiolgist of my previous MRIs read it this morning and states "unchanged". That is a long time between MRIs but like many physicians I am the last to take my advice. Still would like your answer or comments and will pay you promptly. Obviously, I have chosen a conservative path of observation over surgery for a number of years primarily out of fear of complications with the hope that there will be continued to be no growth. Prior MRIs from 06 were also the same. My Neurologist locally will also get copies of the MRIs to confirm that comparable alignment and segment depth were used. All the best...jeff

 

The fact that there has been no change in 3 years is, of course, an excellent sign. The argument for surgery, which you probably already know, is that surgery goes best when you are in good medical health.

 

I thought this article on natural history might be of interest to you. I heard the paper presented last year and it helped me in some situations

 

J Neurosurg 2010 Apr 30. [Epub ahead of print]

Treatment decision making based on the published natural history and growth rate of small meningiomas.

Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, McDermott MW, Parsa AT.

Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California.

Abstract

Object Definitive data allowing clinicians to predict which meningioma patients will fail to respond to conservative management are lacking. To address this need, the authors systematically reviewed the published literature regarding the natural history of small, untreated meningiomas. Methods The authors performed a systematic review of the existing literature on untreated meningiomas that were followed with serial MR imaging. They summarize the published linear rates of tumor growth, and the risk factors for development of new or worsened symptoms during follow-up by using a stratified chi-square test. Results The search methods identified 22 published studies reporting on 675 patients with untreated meningiomas followed by serial MR imaging. Linear growth rates varied significantly: no growth was the most common rate, although reports of more aggressive tumors noted growth rates of up to a 93% linear increase in size per year. The authors found that few patients with initial tumor diameters < 2 cm went on to develop new or worsened symptoms over a median follow-up period of 4.6 years. Patients with initial tumor diameters of 2-2.5 cm demonstrated a marked difference in the rate of symptom progression if their tumors grew > 10% per year, compared with those tumors growing </= 10% per year (42% vs 0%; p < 0.001, chi-square test). Patients with tumors between > 2.5 and 3 cm in initial size went on to develop new or worsened symptoms 17% of the time. Conclusions This systematic review of the literature regarding the clinical behavior of untreated meningiomas suggests that most meningiomas </= 2.5 cm in diameter do not proceed to cause symptoms in the approximately 5-year period following their discovery. Those that do cause symptoms can usually be predicted with close radiographic follow-up. Based on these findings, the authors suggest the importance of observation in the early course of treatment for small asymptomatic meningiomas, especially those with an initial diameter < 2 cm.

PMID: 20433281 [PubMed - as supplied by publisher]

 

I hope that helps, and again apologize for taking so long to get back to you.

 

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