Our Summary

This research paper discusses meningiomas - the most common type of primary brain tumor that occurs outside the brain substance itself. Although these tumors often grow slowly and are not highly aggressive, surgically removing them can be complex, especially when they are located at the base of the skull. The success of the surgery heavily relies on the right choice of surgical opening in the skull (craniotomy) and the surgical procedure used. These decisions are crucial to prevent any unnecessary damage to the brain, ensure the entire tumor is visible and can be completely removed. The article provides a detailed overview of different types of skull openings and surgical methods used for meningioma removal, with the help of dissections on cadavers (dead bodies used for medical training) and surgery videos.

FAQs

  1. What are meningiomas and how common are they as intracranial extra-axial primary tumors?
  2. Why is the selection of appropriate craniotomy and approach important in the resection of meningiomas?
  3. What techniques are illustrated in the article to perform craniotomies and their approaches to meningiomas?

Doctor’s Tip

One helpful tip a doctor might give a patient about craniotomy for meningioma is to ensure that they follow all pre-surgery instructions provided by their medical team, such as fasting before the procedure and taking any prescribed medications as directed. It is also important for the patient to discuss any concerns or questions they may have with their surgeon before the surgery to ensure they have a clear understanding of what to expect during and after the procedure. Additionally, the doctor may advise the patient to follow post-operative care instructions carefully to promote proper healing and recovery.

Suitable For

Patients who are typically recommended craniotomy for meningiomas include those with large or symptomatic tumors, tumors causing mass effect or compression on surrounding structures, tumors located in difficult-to-access areas such as the skull base, and tumors that are suspected to be high grade or aggressive. Additionally, patients who have failed or are not candidates for other treatment modalities such as radiation therapy may also be recommended for craniotomy. The decision to recommend craniotomy is based on the individual patient’s specific tumor characteristics, overall health status, and surgical risks and benefits.

Timeline

Before craniotomy:

  1. Patient presents with symptoms such as headaches, seizures, weakness, or changes in vision that prompt a visit to a healthcare provider.
  2. Diagnostic imaging studies such as CT scans or MRI scans are performed to confirm the presence of a meningioma.
  3. Neurosurgical consultation is conducted to discuss the need for surgical intervention.
  4. Preoperative evaluation and preparation are done, including medical history review, physical examination, and blood tests.

After craniotomy:

  1. Patient undergoes general anesthesia and positioning for surgery.
  2. Neurosurgeon performs the craniotomy, which involves making an incision in the scalp, drilling a hole in the skull, and removing a portion of the skull to access the brain.
  3. Meningioma is carefully dissected and removed, with the goal of achieving complete resection while preserving surrounding brain tissue.
  4. The skull is then repaired and closed with sutures or metal plates.
  5. Patient is monitored in the intensive care unit or neurosurgical ward postoperatively for any complications.
  6. Depending on the extent of the surgery and the patient’s recovery, rehabilitation and follow-up appointments may be necessary.

What to Ask Your Doctor

  1. What is the purpose of a craniotomy in treating my meningioma?
  2. What are the potential risks and complications associated with a craniotomy?
  3. How long is the recovery period after a craniotomy?
  4. Will I need any additional treatments or therapies after the craniotomy?
  5. Can you explain the specific craniotomy technique and approach you plan to use for my meningioma?
  6. How experienced are you in performing craniotomies for meningiomas?
  7. What are the chances of complete resection of the meningioma with this craniotomy?
  8. Will I need any special post-operative care or follow-up appointments after the craniotomy?
  9. Are there any alternative treatment options to a craniotomy for my meningioma?
  10. What is the long-term prognosis for my meningioma after undergoing a craniotomy?

Reference

Authors: Zhao X, Tavakol SA, Pelargos PE, Palejwala AH, Dunn IF. Journal: Neurosurg Clin N Am. 2023 Jul;34(3):381-391. doi: 10.1016/j.nec.2023.02.004. Epub 2023 Apr 7. PMID: 37210127