Meningioma

People diagnosed with the brain tumourmeningioma, nowadays have several efficient treatment methods available. Choice of the right treatment method depends on each particular situation. In order to prescribe the most efficient and safest treatment method for you, our specialists have to assess the stage and spread of the disease, the level of aggressiveness of tumour, previous health examinations and treatment.

Radiosurgery Centre Sigulda offers meningioma treatment with last generation robotic system CyberKnife M6. Treatment of meningioma with radiosurgery does not involve surgical intervention, anaesthesia and blood loss.

Treatment of tumours in head with CyberKnife® M6 Step by step

How can we help if you are diagnosed with meningioma?

  • After establishment of the Radiosurgery Centre Sigulda (2015) our clinic offers the world's most advanced non-invasive meningioma treatment with the Cyberknife®M6 robotic radiation delivery system;
  • CyberKnife® M6 radiosurgery ensures 98% of growth control of a tumour as well as minimal side effects;
  • Our team consists of experienced, highly qualified specialists (neurologist, neurosurgeon, neuro radiologist, radiation oncologist) specialising in diagnosing and treating of meningiomas;
  • Each individual case is assessed by the specialist team — within the framework of the board of specialised doctors;
  • The most advanced methods for diagnosing tumours in the head, for example, 3 Tesla MRI scan, 64 slice CT scan, PET-CT scan, are available to our patients.
  • Our specialists perfectly know conventional treatment methods for meningioma and have gathered more than twenty years of experience in using them for meningioma treatment;
  • Our specialists work according to the guidelines of the professional associations on the basis of recent clinical trials and experience of the leading European clinics, in line with especially elaborated protocol for meningioma treatment;
  • Results of patients treated during two years’ period completely correspond to the results of the leading CyberKnife centres in Europe both in terms of efficiency and safety;
  • The main task of our specialists is to offer diagnostics and treatment method that is most suitable for you.

Ask here and our specialists will help you to understand your situation and find the best solution in your case.

Treatment of meningioma with CyberKnife — 2 years before and after

Meningioma treatment methods

Several methods or their combinations are used to treat meningioma:

  • Neurosurgery;
  • Radiation or radiosurgery;
  • Medical treatment aimed at reducing cerebral oedema;
  • Regular surveillance.
Meningioma treatment tactics

Treatment of grade I meningioma may include the following:

  • Active surveillance — small-sized tumours without neurological symptoms;
  • Surgery to remove a tumour. If tumour tissues remain after the surgery, post-operative radiotherapy / radiosurgery is indicated;
  • Robotic radiosurgery in case of tumours less than 3 cm in diameter;
  • Radiotherapy / radiosurgery in case of deeply located, inoperable tumours;

Grade II and III meningioma is treated with surgery and radiotherapy.

Surveillance of meningioma

Not every meningioma detected needs immediate treatment.

If the meningioma has been detected in a CT or MRI scan as an incidental finding, it is small and features no clinical symptoms, it is recommended to continue surveillance of the tumour and repeat MRI scan every 6 months.

CyberKnife treatment of meningioma

Radiosurgery procedure with CyberKnife as an optional alternative may be used in case of small tumours that are hard to access and also where a neurosurgery has been rejected for a patient due to medical reasons. Radiosurgery is often used to radiate recurring tumours, as well as in combination with microsurgery where the tumour cannot be removed fully during a surgery due to its location. In majority of cases radiosurgery ensures high tumour control. Rather frequently, within 2 years after the radiosurgery, one can detect decrease in tumour mass by 20-25%, in comparison to the condition before the manipulation. Regardless of efficiency of the method and accuracy of radiation delivery from different radiosurgery equipment, both results and side effects may vary after the procedure. The main shortcoming of the method — decrease in tumour's size is gradual therefore if a patient had complaints about symptoms caused by the tumour, they will also reduce gradually.

In order to achieve ultimate effect and to reduce side effects caused by the tumour and radiosurgery to an extent possible, it is important to use the most advanced diagnostic examinations to prepare the planning of the radiosurgery: 3 Tesla magnetic resonance imaging and at least 64 slice computed tomography scan, because with radiosurgery it is possible to radiate the tumour to a precision of a millimetre.

Neurosurgery of meningioma

Optional method — neurosurgery or microsurgery is routinely chosen due to the size of a tumour:

  • It presses on the brainstem;
  • Prominent mass effect;
  • Increased intracranial pressure;
  • And / or complaints about aggravating condition becoming unbearable.

The goal is a complete or partial removal of a tumour provided that the tumour is superficial or surgically accessible and distinguishable without additional neurological defect.

Compared to neurosurgeries performed in the beginning of the last century, patient mortality from such manipulations have decreased from 80% to 2%, however one must bear in mind that the surgery can still lead to relatively severe post-operative complications:

  • Damaged surrounding healthy tissues, bleeding and increased risk of infections as well as increased risk of thromboembolism;
  • Accumulation of cerebrospinal fluid in the operated area, meningitis, cerebrospinal fluid reflux disorders;
  • In approximately 20% of cases patients might suffer from seizures if such were absent before;
  • Often a neurological defect develops after the surgery, such as muscle weakness, speech problems or disturbed coordination. These symptoms depend on the location of the tumour, nevertheless they may disappear with time.
Medical treatment of meningioma

If oedema is detected in tissues surrounding the meningioma, it is a common practice to subscribe medications to reduce cerebral oedema before a surgery or radiosurgery. Usually medications to treat oedema must be administered for a prolonged period, also after the treatment.

Advantages of treatment with CyberKnife

High efficiency and safety

Robotic radiosurgery with the CyberKnife M6 system is efficient and safe method based on clinical trials — known for more than 15 years.

Proven results

Expected therapeutic results are based on quantitative clinical research and qualitative clinical research; efficiency is proven in patient surveillance for more than 15 years;

In 97% of cases where meningioma is treated with CyberKnife, a tumour is expected to stop growing or reduce in size by 20-25% in the course of next 2 years after the treatment;

Using CyberKnife to treat small and medium-sized meningiomas, no prolonged recovery and rehabilitation is required after the therapy, side effects tend to not be more severe than those triggered by the tumour and can be controlled with appropriate medical treatment.

Painless procedure

Meningioma growth is stopped without chemical interference, without pain, without a need for rehabilitation, at a precision of a millimetre, ultimate prevention of a human mistake and minimum risk of side effects.

Protects healthy tissue

Maximum dose of radiation is delivered directly to the tumour from many different angles with sub-millimetre precision, allowing linear accelerator of the radiosurgery system CyberKnife® M6 targeting the affected tissue while minimising exposure to nearby tissues.

Comfort during the procedure

A patient may lay and breathe freely during the robotic radiosurgery. The system spots even the slightest patient movements and adjusts accordingly. For safety reasons the patient has a light thermoplastic mask during the procedure, and usually it does not cause unpleasant sensations and claustrophobia. Unlike other radiosurgery methods, such as Gammaknife, a patient does not require a stereotactic frame or tight fixation mask, commonly used in other radiosurgery systems.

Can be combined with conventional therapy methods

If meningioma has been detected where it already has serious side effects, robotic radiosurgery can be combined with microsurgery thus reducing mass effect on other parts of the brain;

If there is a risk of recurrence after previous surgery or it was not possible to remove the tumour entirely, the remaining tissue can be destroyed with CyberKnife.

Improves quality of life

Majority of our patients, two years after the radiosurgery with CyberKnife, no longer feel the symptoms of disease and are satisfied with their choice.

Radiosurgery with CyberKnife makes patients feel better, because it destroys the tumour in a comfortable and efficient way, not affecting the quality of life.

Return home the same day

Radiosurgery with CyberKnife is a treatment on out-patient basis. After the procedure you can go home the same day and no hospital stay is required.

Predictable costs

Unpredictability of real costs related to the disease can actually make your budget vulnerable:

  • If you need a diagnosis you might have to wait in a long queue for another MRI scan and be left wondering about what does the opinion says,
  • A neurosurgery can be related to hardly predictable post-operative care and rehabilitation costs, which are not routinely covered from the state budget,
  • Unclear picture of doctor's fee,
  • These are issues raising the stress level and leading to anxiety in already complicated period of disease.

We have tried to elaborate our service price list to make costs of diagnostics and therapy transparent and predictable.

However, if you have any question about possible costs, please ask our customer consultants.

View our service price list here.

Treatment of tumours in head with CyberKnife

Treatment of tumours in head with CyberKnife

First step: Consultation and assessment of treatment options

In order to evaluate efficiency for treatment of tumours in head with the CyberKnife® M6 system, it is possible to take individual free of charge on-line patient consultation where data from medical history are assessed.
In order to apply for a consultation, please send data from on-line contact form and data uploading form here.
Data necessary to initially assess treatment options:
• Magnetic resonance imaging (MRI) with a description or access code to the scan in a data base or images of the scan in DICOM format, recorded in CD, or uploaded in data uploading system at the hospital's website (preferably not older than 4 weeks).

Consultations in the Centre.
Possible therapy tactics, side effects and course of the therapy are explained in a consultation. Image data from previous analyses and diagnostic radiology are demonstrated and explained.

Tumour board.
The Medical Treatment Law stipulates that treatment tactics of each patient is examined in a multidisciplinary tumour board consisting of a neurosurgeon, radiation oncologist and radiologist. The treating doctor presents patient's medical data to the members of tumour board. If necessary, the patient is invited to attend the tumour board in person to directly discuss different aspects of treatment with the tumour board members.

Step two: Topometry
Step three: Drawing up of individual treatment plan
Step four: Radiosurgery procedure with CyberKnife
Step five: Post-treatment

Brain tumour – meningioma

Brain tumours

Brain tumours

There are more than 40 types of tumours, localised in the brain and spinal cord. They are divided into two groups depending on the aggressiveness level of tumour:

  • benign tumours (grade I and II anaplastic tumours),
  • malignant tumours (grade III and IV anaplastic tumours).

Benign tumours grow slowly, in the course of many years, and rarely spread outside the borders of tissues from which they form (for example, meningiomas, pituitary adenomas, schwannomas). Unlike benign tumours, malignant tumours grow fast, progressively and usually infiltrate the structures of other tissues and can spread to other parts of the brain or spinal cord. The most common tumours are anaplastic astrocytomas, oligodendrogliomas, glioblastomas and gliomas with combined structure. Tumours originating in the brain are called primary brain tumours. Main brain tumours can spread to other parts of the brain or spine, however they rarely invade other parts of the body.

Most frequently occurring primary brain tumours in descending order:

  • Anaplastic astrocytomas and glioblastomas (38% of all primary brain tumours)
  • Meningiomas (27% of all primary brain tumours)
  • Pituitary tumours
  • Schwannomas
  • Brain lymphomas
  • Oligodendrogliomas
  • Ependymomas
  • Low grade anaplastic astrocytomas
  • Medulloblastomas
  • A tumour originating in another body part and spreading to the brain is called metastatic (secondary) brain tumour. Metastatic brain tumours are more common than primary brain tumours. In up to half of the cases the metastatic brain tumour is caused by the lung cancer. Also melanoma, breast cancer, colon cancer, renal cancer, nasopharyngeal cancer and others.
  • Medulloblastomas.

A tumour originating in another body part and spreading to the brain is called metastatic (secondary) brain tumour. Metastatic brain tumours are more common than primary brain tumours. In up to half of the cases the metastatic brain tumour is caused by the lung cancer. Also melanoma, breast cancer, colon cancer, renal cancer, nasopharyngeal cancer and others. 

What is brain tumour – meningioma?

Meningioma is a slow-growing, mainly benign tumour that forms on membranes that cover the brain and spinal cord. Meningiomas are rather common and make one fourth of all primary brain tumours. Quite often meningiomas grow between the brain and skull bones, as well as between both cerebral hemispheres. In 90-95% of cases meningiomas are benign, in 5-7% of cases they can be atypical, whereas in 1-2% of cases they are malignant. Spinal cord meningiomas occur not more often than in 10-12% out of all cases of meningiomas. Meningioma is more likely with age, reaching its maximum at 60-70 years, however it may develop also in younger patients.

Facts about meningioma

Etiology — risk factors frequently linked to development of meningioma:

  • Neurofibromatosis type 2;
  • Hormone replacement therapy used for a prolonged period by women during the menopause (tumour is twice as common in women than men);
  • Radiotherapy in childhood.

Epidemiology of meningioma:

  • Diagnosed between 45 and 80+, most frequently at 53 years of age;
  • Detected in 3-4 men and 9-13 women on average per 100 thousand inhabitants;
  • 20-30% of all primary tumours in head;
  • Most common tumour of the central nervous system;
  • 1/3 of patients have neurological symptoms before surgery (headaches, dizziness, visual, cognitive, motor skill and speech disorders).

Classification of meningiomas (WHO classification):

  • Grade I - malignant meningioma (90-95%);
  • Grade II - atypical malignant meningioma (5-7%);
  • Grade III - anaplastic / malignant meningioma (1-2%).

Prognosis:

  • Very good for the most part, but differs depending on histology and therapy applied;
  • 5 years' survival rate for patients with grade I meningioma >90%, with grade III — 50-60%;
  • Local control of tumour >95% for benign meningiomas (disease stabilisation).

After neurosurgery of meningioma:

  • 2% post-operative mortality, 9.5% mortality 5 years later;
  • 10 years’ of local recurrence frequency after the radical surgery — 9% after non-radical surgery — 40%;
  • Neurologic defect possible, increased risk of infection.

After neurosurgery of meningioma: 

  • 2% post-operative mortality, 9.5% mortality 5 years later; 
  • 10 years’ of local recurrence frequency after the radical surgery — 9% after non-radical surgery — 40%; 
  • Neurologic defect possible, increased risk of infection. 
Meningioma symptoms
  • Meningioma tumours usually grow “inwards” therefore they build a pressure or compression on the brain or spinal cord, as well as deformation. Compression can be a cause of headache, disturbed vision, balance, dizziness, seizures, even epilepsy (it depends on the area of brain where the meningioma is located);
  • The symptoms may vary depending on the size and location of the tumour, and also visual or olfactory and balance disorders, for example, can be related to a pressure of meningioma on nearby nerves. If the tumour is located in the spinal canal, it may depress spinal cord causing leg or hand weakness and changes in sensitivity;
  • If meningioma depresses brainstem, the headache due to mass effect and increase of intracranial pressure may become unbearable and lead to severe vomiting and disorientation disorders;
  • Patients may have changes in speech or personality, mood, concentration capacity or behavioural changes.
Diagnostics

Meningiomas are most often detected when patients complain about headaches or disturbed vision and also accidentally — if a MRI scan is performed for diagnostic purposes. If the MRI scan is performed properly, it is possible to detect tumour of 2-5 mm in size, however most commonly tumours exceeding 5 mm in diameter are found. Meningiomas are easy to visualise with MRI (with a contrast agent), however, if the situation is not clear, other diagnostic methods can be recommended: computed tomography, positron emission tomography (PET-CT).

Radiosurgery Centre Sigulda specialists

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