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Meningiomas of the Skull Base: Comprehensive Overview and Treatment Options

Bobby Howard

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Published in Meningiomas Of The Skull Base: Treatment Nuances In Contemporary Neurosurgery

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Meningiomas are tumors that arise from the meninges, the protective membranes that surround the brain and spinal cord. While they can occur anywhere in the central nervous system, meningiomas of the skull base are particularly challenging to treat due to their proximity to critical structures. These tumors can cause a wide range of symptoms, from headaches and visual disturbances to seizures and neurological deficits. Understanding the unique characteristics and treatment options for meningiomas of the skull base is crucial for optimal patient outcomes.

Epidemiology and Pathophysiology

Meningiomas are the most common primary tumors of the central nervous system, accounting for approximately 37% of all cases. They typically occur in older adults, with a peak incidence between 40 and 60 years of age. Women are more commonly affected than men. The exact cause of meningiomas is unknown, but certain risk factors have been identified, including a family history of the disease, radiation exposure to the head, and certain genetic mutations.

Meningiomas of the Skull Base: Treatment Nuances in Contemporary Neurosurgery

by Donald L. Budenz

5 out of 5

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Clinical Presentation

The clinical presentation of meningiomas of the skull base varies depending on the tumor's location and size. Common symptoms include:

Headaches
Visual disturbances, such as blurred vision, double vision, or loss of peripheral vision
Hearing loss or tinnitus
Facial weakness or numbness
Seizures
Neurological deficits, such as difficulty with balance, coordination, or speech

Diagnosis

The diagnosis of meningiomas of the skull base is based on a combination of clinical symptoms, physical examination, and imaging studies. Imaging tests commonly used include:

Magnetic resonance imaging (MRI) with gadolinium contrast is the most sensitive and specific imaging modality for meningiomas.
Computed tomography (CT) scan with contrast can provide additional information about the tumor's extent and relationship to surrounding structures.
Angiography may be necessary to visualize the tumor's blood supply.

Treatment Options

The treatment options for meningiomas of the skull base depend on factors such as the tumor's size, location, and the patient's overall health. The primary treatment modalities include:

Observation

Observation may be recommended for small, asymptomatic meningiomas that are not causing any significant symptoms. Regular follow-up imaging is necessary to monitor the tumor's growth.

Surgery

Surgery is the primary treatment for meningiomas that are causing symptoms or are growing rapidly. The goal of surgery is to remove the tumor while preserving neurological function. Skull base surgery is a complex and delicate procedure that requires a highly skilled surgeon with experience in this specialized area.

Radiation Therapy

Radiation therapy can be used to reduce the size of meningiomas or to prevent their recurrence after surgery. Stereotactic radiosurgery is a type of radiation therapy that delivers a high dose of radiation to a targeted area with minimal damage to surrounding tissues.

Medical Therapy

Medical therapy may be considered for patients who are not candidates for surgery or radiation therapy. Medications that are commonly used to treat meningiomas include:

Hormonal therapy, such as octreotide or mifepristone, can block the growth of meningiomas that are hormone-sensitive.
Anticonvulsants can be used to prevent seizures.
Pain relievers can be used to manage headache pain.

Prognosis

The prognosis for patients with meningiomas of the skull base depends on the tumor's size, location, and the extent of surgical resection. With early diagnosis and appropriate treatment,

Meningiomas of the Skull Base: Treatment Nuances in Contemporary Neurosurgery

by Donald L. Budenz

5 out of 5