Gliomas, meningiomas: surgical management of brain tumours by an FMH neurosurgeon.
There are different types of brain tumours. Primary brain tumours or intra-axial tumours that take their origin from primary cells of the brain parenchyme (gliomas for example). Intracranial extra-axial tumours (meniningiomas, neurinomas for example) take their origin from cells outside the brain parenchyme (menineges, external sheat of the cranial nerves). Meningiomas arise from cells in the meninges.
Gliomas are primary brain tumours ranging form low grade to high grade according to the WHO classification. They can localise in different regions of the brain parenchyme.
Symptoms and clinical signs are determined either by the localisation of the tumour that can be adjacent to language or motor regions or by the pressure that causes the tumour on the brain. Patients will then suffer from raised intracranial pressure (severe headaches, nausea, vomiting and/or drowsiness).
In general, primary brain tumours can be surgically resected but this depends on the localisation of the tumour in the brain and whether it is too close to vital functions of the brain.
Meningiomas are intracranial extra-axial tumours, usually benign and take their origin from cells in the arachnoid membrane (one of the three meninges). The meningioma has a low annual growth rate but very slowly can cause progressive distortion of the brain parenchyme.
Symptoms caused by the progression of meningiomas are determined by the compression of eloquent structures of the brain or by the raised intracranial pressure if the brain distortion is too important.
In general meningiomas can be surgically removed.
In general, a tumour can be surgically removed (craniotomy) if its location allows; a brain biopsy may also be indicated. Each situation is discussed in a multidisciplinary manner. All cranial surgery is performed in the appropriate hospitals of French-speaking Switzerland according to complexity.
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A meningioma is generally a benign, slow-growing tumour. Its management depends on size, location and symptoms.
No. Some warrant simple MRI surveillance; the decision is made case by case, often multidisciplinarily.
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