Tumours of the brain that arise from the lining membrane of the skull and skull base called the dura. They can also occur in the spine. These tumours are usually benign and slow growing. They can also arise from the membrane between the two halves of the brain which is a fold of the dura called the falx or from the tentorium which separates the hemispheres from the cerebellum and brain stem. Rarely meningiomas can also be found within the ventricles.
SYMPTOMS
Many meningiomas are often found by accident when having a CT or MRI scan of the head. Small incidental meningiomas not causing any symptoms may be monitored with repeat CT or MRI scans and treated if there is a change in symptoms or size of the tumour.
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Larger meningiomas may present with symptoms such as headache, nausea or vomiting or more often may present with seizures. It is also possible, depending on the location of the tumour to present with other focal neurological deficits or cognitive dysfunction.
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DIAGNOSIS
A meningioma can been seen on CT scans preferably with contrast or better visualised on an MRI scan with contrast.
The majority of these tumours are benign and it is rare for them to be malignant.
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TREATMENT
Treatment of meningiomas is best achieved by surgical resection including the dural base and attachments where possible. Usually a craniotomy is performed for this. Complete surgical resection is usually curative although patients have ongoing monitoring with imaging for recurrence. If the tumour is malignant then radiotherapy may also be necessary. Radiotherapy or radiosurgery can also be used for inoperable tumours which have been as deemed necessary.
Gliomas are the most common type of primary brain tumour. They can occur anywhere in the cerebellar hemispheres or, rarely, in the cerebellum or spinal cord or brain stem. There are tumours that arise from the glial or supporting cells for the neurons. There are a variety of types, depending on the cell type. The most common type of these tumours is called a glioblastoma multiforme (GBM). This is a rapidly growing tumour that infiltrates the brain. It is the most common type of primary brain tumour. These tumours are malignant. They are graded as a grade 4 glioma.
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The grading of a glioma reflects how aggressive it is. Grade 1 tumours are usually seen in childhood and are benign (pilocytic astrocytoma). Grade 2, or low-grade, gliomas can be seen in younger people. These tumours may progress to more aggressive forms. Grade 3 is an anaplastic or glioma. Grade 4 is a malignant glioma. Both grade 3 and grade 4 tumours are considered malignant and warrant other adjuvant therapy.
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SYMPTOMS
These tumours may present with a neurological deficit or, sometimes, present with symptoms such as seizures. Other symptoms include headache, nausea, vomiting, or change in personality or neurological function.
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DIAGNOSIS
These tumours can be imaged with CT and MRI with contrast.
TREATMENT
Treatment options include surgery to debulk the tumour, adjuvant radiotherapy and chemotherapy (temozolomide). There can be a number of factors influencing the best treatment options, and these can be discussed with your surgeon and oncologist.
Metastatic tumours to the brain or secondary tumours are one of the most common forms of brain cancer. Any malignant tumour may metastasise to the brain, however, the most common types are from melanoma, lung, breast, bowel and kidney cancer. These tumours may be discovered incidentally in people having staging workup for known metastatic disease.
SYMPTOMS
Most common symptoms for cerebral metastasis, such as headaches, nausea, vomiting, seizures or other neurological symptoms.
DIAGNOSIS
Metastasis to the brain can be identified by CT scan, MRI scan or PET. There may be a single metastasis to the brain or even multiple metastases.
TREATMENT
There are multiple treatment options for cerebral metastasis including no treatment, surgery, radiotherapy, stereotactic radiosurgery (focused radiotherapy), chemotherapy and immunotherapy. Often many of these treatment options are combined. There are many factors in considering which is the best treatment option and these need to be discussed with your surgeon or oncologist.
Pituitary tumour is an abnormal cellular growth in the pituitary gland located in the brain. Pituitary gland releases hormones that act directly on the body tissues and also regulates the production of hormones from other glands such as thyroid and adrenal gland. Thus pituitary tumours lead to overproduction of one or more hormones causing conditions such as hyperthyroidism, gigantism, Cushing’s syndrome and abnormal discharge from the nipples of the breasts. As they grow they may put pressure on the optic nerve affecting vision. Their diagnosis is thus made on the basis of endocrine function test for cortisol, follicle stimulating hormone, insulin growth factor-1, luteinizing hormone, serum prolactin, testosterone and thyroid hormone levels. The diagnosis is further confirmed by MRI of the head.
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Most of these tumours are non-cancerous and do not spread to other areas of the body. The treatment involves radiation, medications and surgery as monotherapy or combination therapy. The surgery is essential when the tumour is pressing the optic nerve and may cause blindness. Most of these tumours are removed through nose and sinus without external incision using endoscopic transnasal transsphenoidal approach. However in case the tumour is big it is removed through the incision in the skull (transcranial approach).
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