...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.
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.
Please ask follow up questions that you may have