An Advanced Approach To Control Parasellar And Sellar Skull-base Meningiomas Through Pakistans Best Ever Gama Knife Stereotactic Radiosurgery At NCCI
In general a brain tumor is a mass or growth of abnormal cells in the brain. A meningioma is the most common extra-axial or intracranial slow-growing brain tumor that arises from the meninges of the brain, targeting an individual’s neurological and motor function and is seen in variety of age groups but most commonly in middle aged females which may present with headache, decreased level of consciousness, pupillary changes, Altered respiratory pattern, seizures , vomiting and change in posture due to weakened motor function.
Throughout centuries surgeons have sought out ways to treat brain tumors but what makes para sellar and sellar meningiomas a challenge is their firm consistency and vascularity, and their proximity to critical neuroendocrine, vascular, and cranial nerve (CN) structures. Such features usually hinder complete resection, whether by endoscopic or skull-base approaches, increasing chances of reoccurrence of the tumour after initial surgery.
An advanced approach used by modern-day surgeons in order to combat this uphill battle is the use of Gamma knife Stereotactic radiosurgery Which has been advocated for recurrent sellar and parasellar meningiomas after resection or as an upfront treatment which has statistically proven to be effective in 93% of cases . With the addition of GKRS to the neurosurgical and radiation oncology armamentarium, the pendulum has swung away from both aggressive resection and fractionated radiation therapy for skull-base meningiomas , reducing morbidity and mortality rate to a greater extent in individuals.
Patients looking for convenient and effective treatment go for early radiosurgery for smaller-volume tumors or subtotal resection followed by radiosurgery for larger-volume tumors with symptomatic mass effect .Both strategies place a premium on the preservation of neurological function. So to emphasise more on how effective this treatment can be , let’s look at a case: In 2012 a middle aged , career oriented woman got diagnosed with a brain tumour at NCCI. She had complains of headache, nausea, migraine and fatigue due to which oncologists and surgeons at the hospital recommended radiotherapy after taking into consideration the size and anatomical location of the tumor.
The patient according to plan was given a low gray dose and told to revisit after 6 months. The MRI results after 6 months showed significant shrinkage in the size of the tumor and a complete recovery was observed , keeping the patient Asymptomatic for more than 9years but since the tumour had a typical histological origin, the patient had to revisited NCCI with left eye ptosis indicating the reoccurrence of the meningioma. This time the meningioma was more aggressive and required immediate attention to control it’s progression and thankfully at NCCI some expert neurosurgeons and an amazing staff worked in coordination to tackle this problem.
A smart strategy of giving radiation dose in fractions of five to this large sized tumor was applied and later on a booster dose of about 5 gray was given to the patient to prevent it’s progression further. The recent MRI findings of this patient show no demonstrable tumor growth and an improved left eye oedema. In fact this woman even hasn’t left her job and continues to work as a doctor and a house wife. This woman is my mother.
Regards Dr. Asifa