S3E13: Devastating medical news. Meningioma brain tumor.

On today’s show we pick up right where we left off on yesterday’s show.  Meena gives us a deep dive into the process of learning about and later having surgery for a meningioma brain tumor.

The meningioma, according to Johns Hopkins, is the most common type of brain tumor and the most treatable.

Meena, a certified yoga and Pilates instructor had been suffering from symptoms of what she believed to be an inner ear infection.   But after tests, with an ear nose and throat doctor, she discovers she needs a neurologist. 

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We begin the story there.  Meena has just had an MRI and she is about to get the results that will change her life…

What is a meningioma?

From Johns Hopkins website:

Meningiomas are the most common kind of brain tumor — accounting for about 30 percent of all brain tumors — and most are treatable. In fact, the majority of these tumors can be removed surgically, and many do not return.

Meningiomas arise from the layers of membrane that cover the brain and spinal cord, not from the brain tissue itself. Some 90 percent of meningiomas are benign — that is, they are not likely to spread throughout the body — and they tend to grow slowly over months or even years.

However, meningiomas can become quite large, and crowd the brain and other structures inside the skull. As meningiomas grow, they increase pressure within the skull and cause problems,

Symptoms include:

General pressure inside the head, resulting in headache, nausea and vomiting

Specific symptoms due to location: For instance, a meningioma pressing against an optic nerve may cause visual problems. Another tumor’s location may affect motor skills or speech.

Electrical disturbances within the brain, causing seizures

Because the tumor is not made of brain matter, it is not technically a brain tumor.

Back in 2011, it was reported the late television icon Mary Tyler Moore was undergoing a procedure to have a meningioma brain tumor removed.

“At the recommendation of her neurologist, who has been monitoring this for years, and a neurosurgeon, Mary decided to proceed with this fairly routine procedure,”

Where does the tumor come from?

As discussed in the podcast, people are born with the tumor which most commonly appears in the membrane that cover the brain and spinal cord (called the meninges). 

The tumor grows as you grow usually very slowly.    Like in Mary Tyler Moore’s case the tumor, when found ,is monitored and surgery performed when an MRI shows it’s grown large enough to pose a problem.

Meningiomas are more common in women than in men, usually between the ages of 40 and 70. 

They can be found in the cite of previous head trauma such as skull fractures, in areas of the brain exposed to radiation and in people with a genetic disorder known as neurofibromatosis type 2 (Nf2).

What is neurofibromatosis

In the podcast, Meena’s doctor mentions a genetic component connected to the tumor and other brain disorders like  Parkinson’s or Alzheimer’s. 

This conclusion appears to be speculator at best.  There are some studies that want to link Parkinson’s with brain tumors but the conclusions are far from complete.    

The research does seem to link neurofibromatosis, a genetic condition, with meningioma.

From Cancer.net

Neurofibromatosis type 2 (NF2) is a hereditary condition most commonly associated with bilateral vestibular schwannomas, also known as acoustic neuromas. These are benign (noncancerous) tumors that occur on the nerves for balance and hearing leading to the inner ear. Although these tumors are benign, they can cause hearing and balance problems.

People with NF2 also have an increased risk of other tumors of the nervous system. These tumors are generally not cancerous, but they may still lead to significant medical problems, especially if there are multiple tumors in or next to the brain. Other nervous system tumor types include:

Schwannomas of other nerves

Meningiomas, a slow-growing tumor that usually develops on the surface of the brain

Gliomas, including ependymomas of the brain or spinal cord

The article goes on to point out it is estimated that about 1 in 40,000 people has NF2. About 50% of people with NF2 do not have any family history of the condition.

NF2 causes a mutation in the tumor suppressor gene of the body.  The mutation increases the risk of a person with NF2 getting cancerous or benign tumors.

The mutation is passed down from a single defective gene in either the mother or the father.

“Therefore, a child who has a parent with a mutation has a 50% chance of inheriting that mutation. A brother, sister, or parent of a person who has a mutation also has a 50% chance of having the same mutation. However, if the parents test negative for the mutation, the risk to the siblings significantly decreases but their risk may still be higher than an average risk.”

Treatment

Surgery appears to be the major treatment for the condition.  Sometimes radiation can be used if the person is too ill to handle surgery.   But such a treatment may only shrink the tumor not remove it.

In addition, for the rare cases in which the tumor is cancerous, radiation may be used to treat small remains of the tumor.

In some cases a doctor may perform a craniotomy. The procedure surgically cuts a window in the skull. The tumor is then removed through that opening. The opening is repaired at the end of surgery. The incision is usually behind the hairline and is not obvious once it heals.

In some situations, a surgeon may opt to reach the meningioma using an instrument called an endoscope, accessing the tumor through the nose. Again this is dependent on the location of the tumor.

If the tumor is located close on the surface of the brain near the skull (a convexity meningioma), surgery is more straightforward. For meningiomas located deeper in the brain, the surgeon may need to move the brain tissue aside.

Recovery

Studies show eighty percent of patients have satisfactory recovery and improvement with quality of life. As we discuss in our previous blogs and episodes, Meena found herself unable to move her head or speak after surgery.

As mentioned previously, the cite of the tumor is important to the type of surgery and recovery.   Meena was able to walk by roughly the third day and was sent home not long after.

Please listen to the first and second episode in this series, episodes eleven and twelve, to hear how Meena dealt with the pain and discomfort she felt after surgery. 

Using alternative medication learn how she was able to avoid over using heavy prescription medication during her recovery.

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