Meningioma Treatment in India

Meningiomas are a unique and fascinating group of brain tumors arising from the meninges, the terminal and protective membranes around the brain and spinal cord. Although generally considered benign, some meningiomas can exert considerable neurological effects depending upon the size and type. In these sections, we will highlight the variety of types of meningiomas and what makes each unique clinically.

Overview

Meningiomas are treated according to each tumor's size and location, the patient's age, and overall condition. Treatment possibilities include surgical intervention, radiation therapy, or a combination.

The main option for the treatment of meningiomas is surgery, where as much of the tumor as possible is resected. Depending on the size and location of the tumor, a craniotomy may be performed where a section of the skull is excised to allow access to the tumor, or an endoscopic resection may be performed where a thin tube with a small camera is inserted into the brain through a small opening. 

Radiation therapy may be employed along with surgery to limit the chances of recurrence. Sometimes, radiation therapy is also an effective method for reducing the size of tumors not amenable to surgical excision. When tumors spread from the original site to other parts of the body, radiation therapy is also used to treat them. 

Medical intervention, in some cases, includes corticosteroids to decrease swelling and pressure exerted by the tumor; however, these drugs have not been found to decrease tumor size or long-term outcomes.

Besides medical treatments, lifestyle changes, such as minimizing stress, exercising, and getting enough quality sleep, may improve a patient's quality of life. Support groups can also play a pivotal role for the patient and family throughout the journey of having a meningioma.

Thus, treatment for meningiomas is variable and patient-tailored. An interdisciplinary team of doctors and allied health professionals would assist in guiding the patients and their families throughout treatment.

Types

Grade I Meningiomas :

Grade I meningiomas represent the most commonly encountered type and are regarded as benign. Slow-growing and usually encapsulated, they tend to exert pressure on nearby structures, causing symptoms such as headache and visual disturbances. Surgical intervention is possible in most patients, giving them an often favorable prognosis. Classic subtypes include meningothelial, fibrous, and transitional variants.

Grade II Meningiomas:

Grade II-type meningiomas have a more aggressive behavior compared to Grade I due to higher cellularity and mitotic activity. These atypical tumors can infiltrate adjacent brain tissue, rendering complete surgical resection difficult. Although the atypical subtype represents a lesser number of meningiomas, they demand a greater level of caution in management and treatment, including surgery, radiotherapy, and active monitoring. 

Grade III Meningiomas:

Grade III meningiomas are the most aggressive, anaplastic subtypes, growing rapidly with marked cellular and structural abnormalities. Their invasive nature in surrounding tissues and tendency to recur after treatments present major difficulties in management. Medical teams usually offer a multimodality approach that includes surgery, radiation therapy, and chemotherapy in an attempt to avert the tumor's advancement.

Secretory Meningioma:

Among meningiomas, secretory tumors are striking to researchers because of their peculiar features. These tumors secrete substances such as growth hormone, melanin, or follicle-stimulating hormone and produce specific clinical presentations. Rarely found, they elude proper diagnosis and management due to their special hormone secretions, thus requiring careful cooperation among different medical specialists.

Clear Cell Meningioma:

The clear cell meningioma is diagnostically challenging due to its resemblance to other brain tumors. This subtype, which makes up less than 1% of all meningiomas, often affects a younger population and its high vascularization complicates surgical excision. Knowledge of its molecular profile may lead to the possibility of targeted therapies and improved treatment.

Papillary Meningioma : 

Papillary meningiomas have a unique architecture with finger-like processes that limit complete surgical excision. It falls in Grade II, thereby carrying a higher recurrence risk. Investigating the genetic basis regarding these tumors might lead to better treatment prospects in the future.

Symptoms

Meningiomas have the following symptoms that may require treatment:

Persistent Headaches: Constant and frequent headaches that worsen with time may be an early common symptom of a meningioma. These headaches tend to be local; that is, they occur in specific areas of the head and may be associated with a sense of pressure or a feeling of heaviness in that area. However, medical evaluation is required if the headaches are extremely painful, increasing in pain sensations, or interfering with everyday living.

Visual Disturbances: Meningiomas arguing with the optic nerve or optic pathways may present visual disturbances. Patients may complain of blurred vision, double vision, or partial visual loss in one or both eyes. Visual symptoms must never be ignored because an early diagnosis and treatment may avert permanent vision loss.

Seizures: Seizures remain another main hallmark of meningiomas. The location of the tumor in the brain generally determines the types of seizures and their manifestations. Seizures, however, may vary from the very mild, treatment-sensitive focal seizures involving certain parts of the body to the more generalized tonic-clonic seizures with loss of consciousness and convulsions.

Cognitive and Behavioral Changes: Certain locations of meningiomas affect cognitive and behavioral functions. Hence, patients may develop a problem with memory, an inability to focus, confusion, personality changes, or even mood swings. These changes might have a significant impact on the patient's quality of life; hence, medical attention is required.

Weakness or Numbness: Meningiomas that encroach upon the motor areas of the brain or spinal cord may produce paralysis or numbness in certain parts of the body. For instance, a tumor in the frontal lobe may produce weakness in one limb, whereas a tumor in the spinal cord can cause weakness or paralysis below the level of the tumor.

Loss of Sensation: Meningiomas may also cause disturbances in sensory functions; patients could have lost the sensation to touch, feel temperature, or feel pain in certain areas of their body. This symptom would also likely correlate with the location of the tumor along the sensory pathway.

Speech Difficulties: Increased pressure in the brain regions responsible for language processing by a meningioma will cause speech difficulties. Patients may struggle to retrieve words, struggle to put together coherent sentences, or follow along to spoken language.

Diagnosis

Meningioma diagnosis depends on a systematic evaluation, leaving a lot of space for variable presentation and simulating other neurological diseases. Neurologists and surgeons combine their clinical analysis with advanced imaging techniques and, in some rare conditions, a biopsy to untangle the complexities of meningioma detection.

Clinical Assessment: A thorough history and neurological evaluation form the basis of the meningioma work-up. Patients' complaints, including headaches, visual disturbances, seizures, and cognitive complaints, give important hints toward the workup.

Neuroimaging—MRI and CT Scans: Neuroimaging is central to diagnosing meningioma. The most preferred imaging tool is MRI because of its ability to best demonstrate soft tissue like the brain and meninges. MRI allows assessment of the tumor size, its location, and its regard— all for proper treatment planning.

A CT scan is also required to assess the tumor with regard to its location and size. A CT scan has specific relevance in the detection of calcifications in such tumors that are important in diagnosis.

Meningioma Grading: Once imaging confirms the presence of meningioma, the tumor undergoes grading. Meningiomas are graded I through III based on their microscopic appearance and biological behavior. While Grade I is usually regarded as benign, Grades II and III are classified as atypical and anaplastic, respectively, suggesting more aggressive behavior.

Advanced Imaging Techniques: In complex cases, some advanced imaging techniques are directly involved in detailing the tumor and its spatial interactions with surrounding structures. These techniques may involve functional MRI (fMRI), diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (MRS). They generally assist in understanding how the tumor is affecting brain function, which helps in surgical planning.

Biopsy—Confirming the Diagnosis: In some rare cases, where diagnosis is uncertain or for atypical tumors, a biopsy could be performed for diagnosis. Either via needle biopsy or during surgery, a pathologist obtains a small piece of tumor tissue. A pathologist then examines this tissue under a microscope to confirm the diagnosis and establish an appropriate grading.

Genetic Testing: Recent molecular advances have pinpointed some genetic markers concerning meningiomas. Genetic testing can identify certain genetic alterations that may help direct treatment decisions or provide prognostic information.

Risks

Let's review some risks linked with meningiomas:

Neurological Deficits: Depending on the location and size, meningiomas may cause neurological deficits. The deficits may include headaches, seizures, disturbances of vision, weakness or numbness in certain parts of the body, and altered cognition. These neurological deficits can greatly affect the quality of life of a person and may require some medical treatment. 

Mass Effects: Meningiomas grow in the limited enclosed space of the cranium, pushing and compressing the adjacent brain tissue. The mass effect can lead to increased pressure in the intracranial cavity, headaches, vomiting, and alteration of consciousness. In the severest manifestations, mass effect may bring about life-threatening situations requiring urgent intervention. 

Impaired Vision: Meningioma next to the optic nerve or optic pathways may cause impairment in vision or even partial loss of vision. If untreated, vision loss may become permanent, impairing the ability to complete daily functions and further diminishing the quality of life. 

Seizures: About one-third of patients suffering from a meningioma will have seizures because of the presence of the tumor. Seizures are distressing and unpredictable complicating factors in that they greatly influence daily activities and may lead to injuries during seizure episodes.

Recurrence: The majority of meningiomas are slow-growing tumors that are well treated by surgery or radiation therapy, but there remains a probability of recurrence. In some cases, complete surgical resection may theoretically lead to regrowth of these tumors, requiring further treatment and ongoing surveillance. 

Risks of Surgery: Surgical resection is a very common treatment for meningiomas. However, brain surgery carries the same risk of bleeding, infections, and damage to the surrounding brain tissue that will cause neurological deficits. The type of surgery and the skill of the surgical team will weigh heavily in determining the outcome.

Psychological and Emotional Impact: The diagnosis of a meningioma can have a profound psychological and emotional impact on the patients and their families. Dealing with uncertainty about the disease, treatment challenges, and possible recurrence fears can trigger anxiety and depression or even cause emotional distress.

Impact on Daily Life: Depending on the tumor's location and severity of symptoms, meningiomas can impact a person's ability to work, drive, and socially engage. The cognitive and physical impairments caused by the tumor may affect the level of independence with which he lives and thus require support for rehabilitation.

Causes

Meningiomas are interesting brain tumors that originate from the meninges and continue to fascinate researchers because of their enigmatic nature and complicated etiology. None of the exact causes that can push the development of meningiomas remain known, yet some factors and associations have been observed with these tumors through research: 

Genetic Predisposition: In the development of meningiomas, genetics play a very pivotal role. Certain hereditary conditions, such as neurofibromatosis type 2 (NF2) and familial multiple meningioma syndrome, increase the risk of developing meningiomas. Mutations in genes such as NF2 and SMARCB1 have been implicated in the familial case of meningiomas, which sheds light on the genetic basis of these tumors. 

Hormonal Influence: A sizable number of meningiomas have estrogen and progesterone receptors, suggesting that hormonal influences act on tumor growth. Studies have indicated that fluctuating hormone levels during pregnancy and menopause may affect the growth of meningiomas, which are more common in females. However, the exact mechanism linking hormones and meningioma development is still under investigation. 

Ionizing Radiation Exposure: High doses of ionizing radiation exposure, either in the case of radiation therapy for conditions years ago or occupational radiation exposures, have been implicated as risk factors for the development of meningioma. This link is particularly well established in survivors of an atomic bomb explosion, individuals receiving radiation therapy for cancers of the head and neck, and patients with inherited disorders affecting DNA repair. 

Somatic Mutations: Meningiomas can show frequent somatic mutations, which are genetic changes that occur in cells during one's lifetime and are not directly inherited. Researchers have identified mutations in the genes AKT1, TRAF7, and KLF4 in meningiomas, which contribute to tumor initiation and progression. Research continues to illuminate these gene mutations' synergistic effect in meningioma development.

Head Trauma: The association has still not been fully demonstrated, but some studies have supported an association between head trauma and the later development of meningiomas. It is supposed that traumatic brain injuries may elicit the cellular processes that lead to tumor formation, but this remains to be elucidated.

Ethnic and Geographic Variables: Epidemiological studies have indicated differences in the incidence rates of meningiomas among different ethnic groups and geographic areas. However, the reasons for these differences are not yet entirely understood and could encompass a combination of genetic, environmental, and lifestyle factors.

Purpose

Meningioma treatment matters importantly in the lives of the patients diagnosed with these tumors in the brain. The ultimate goal is to empower patients and enhance their quality of life through a multidisciplinary approach that may include surgery, radiotherapy, and medical management in every individual case. Let's discuss the uniqueness and purpose of the treatment of meningiomas: 

Tumor Control and Regression: The treatment of a meningioma primarily aims to inhibit any continued growth of the tumor and, where possible, induce regression. Most benign meningiomas can be suitably treated by surgical resection, where the tumor is taken out with a view to also preserving as much healthy brain tissue as possible. In instances where surgery cannot be performed or there is a risk of recurrence, radiation treatment, applied to eliminate or stun the growth of the tumor, may be opted for.

Therapeutic Effect of Treatments: Meningiomas exert pressure on adjacent brain structures, thereby accounting for a whole range of neurological symptoms, namely headaches, seizures, vision disturbance, and cognitive impairment. Treatments should, therefore, aim at the resolution of these symptoms and improving the well-being of the patient. Post therapeutic intervention, patients recovered from symptoms and improved quality of life after significant reduction in tumor size and mass effect. 

Prevention of Complications: In such cases, if left unchecked, complications like neurological deficits, impaired vision, and even life-threatening mass effect may develop. Timely intervention prevents these complications from worsening and even reverses selected symptoms, allowing patients to lead more functional lives. 

Preservation of Neurological Function: In maintaining neurological function, a key principle of treating a meningioma, neurosurgeons can apply numerous specialized techniques: image-guided surgery and intraoperative monitoring, to name a few, all designed to prevent damage to healthy brain structures during tumor removal. The preservation of neurological function ensures that a patient can maintain cognitive abilities, mobility, and independence.

Long-Term Monitoring and Follow-Up: After the initial treatment, long-term monitoring and follow-up form an integral part of the management of meningioma. Regular imaging and neurological examinations by the treating physician help facilitate early intervention for tumor recurrence or progression, along with creating the best potential outcome. 

Personalized Treatment Approaches: Given the tremendous variability in size, location, and aggressiveness of meningiomas, every case is distinct. The purpose of treating meningiomas is to establish personalized treatment programs tailored to the unique requirements of every individual patient. Multidisciplinary teams join together to reach a consensus on the best means of treatment, considering an array of factors: tumor grade, location, overall health of the patient, and treatment preferences.

Operation & Recovery

Meningioma is a kind of tumor arising from the tissues that protect the brain and the spinal cord. Typically benign, meningioma can undergo surgical treatment if it exhibits signs. The decision will be based on size and tumor location along with patient age and overall health.

The primary treatment for meningioma surgery involves removing the majority of the tumor. Depending on location and tumor size, it can be a craniotomy or craniectomy. Generally, in craniotomy, an incision is made on the scalp, and a piece of skull is removed to expose and remove the tumor. In craniectomy, a surgeon takes a bigger area of the skull for this purpose.

Otherwise, if tumors are deep or difficult to reach, radiosurgery can destroy them. Radiosurgery is very highly focused radiation to kill the tumor cells but not the surrounding healthy tissue.

Occasionally the tumor cannot be removed entirely. In that case, surgery may also be recommended for radiation therapy, where radiation rays damage the remaining cancer cells. It can also decrease the size of the tumor for easier surgery later.

After the patient's operation is finished, the patient usually stays in-house for a few days. The doctors monitor the patient's vital signs and prevent possible complications. Occasionally, the doctors keep the patient for a longer hospital stay, primarily for follow-up treatments or to monitor for potential complications.

Recovery may take several weeks or months, depending on the general condition and age of the patient. Resting and following the doctor's recommendations for dealing with wounds and providing physical therapy are crucial activities during this time. The patient may require medications to reduce pain and inflammation.

Regularly visiting the doctor is essential for them after treating a meningioma, primarily to check for recurrence or side effects from the treatment. In order to receive proper treatment, patients should also inform doctors of newly noticed or worsening symptoms.

This is quite a severe condition that demands prompt intervention. Almost all of them managed to overcome this condition and have a healthy life, given the appropriate care.

Preparation

Before surgery, prepare the affected areas with final instructions using a checklist, which helps the patient understand what to expect before, during, and after surgery. 

1. Pre-operative consultation:

Heating the process of preparation starts with detailed pre-operative consultation with the neurosurgeon. The neurosurgeon reviews the patient's history, performs a neurological examination, and discusses specific details of tumor location, size, and risks. This becomes a good moment for the patient to ask every question or concern as well as understand the surgery better.

2. Neuroimage and review of imaging:

Advanced neuroimaging such as MRI and CT scans is significant regarding the meningioma's association with surrounding brain structures. After that, the neurosurgeon will review them thoroughly to form an exact surgical plan, considering the proximity of the tumor to vital areas in the brain and the best surgical approach.

3. Pre-Operative Tests:

Before the patient could undergo surgery, a shiny collection of preoperative tests had been conducted, including blood tests, ECGs, and chest x-rays. These were the assurances of a fit and healthy patient for the coming procedure and the ability to withstand anesthesia.

4. Review of Medication:

The neurosurgeon and the anesthesiologist reviewed the medications the patient was taking to determine which ones would be continued or stopped for a given time before surgery, such as blood thinners.

5. Instructions for Fasting:

Patients are usually instructed not to eat or drink anything for a specific period prior to surgery. This fasting period is necessary to prevent aspiration during anesthesia.

6. Preoperative Education: 

Patients and their families receive full preoperative education to understand what to expect before, during, and after surgery. This includes information concerning anesthesia, potential risks and complications that might occur, the expected duration of the operation, and the anticipated recovery process. 

7. Psychological Preparation:

Brain surgery is usually an emotional coaster for the patient and family. Psychological support, counseling, and guidance help with any anxiety or doubts about surgery. 

8. Pre-operative skin preparation:

Then, on the day of surgery, the patient's scalp underwent head shaving and antiseptic scrubbing to minimize the risk of infection. 

9. Intraoperative Planning:

In the operating room, advanced technology might also assist through the use of intraoperative imaging and neuronavigation systems, which shall help the surgeon locate the meningioma very precisely and excise it. 

Clinical Trials 

Clinical trials are a beacon of hope for meningioma treatment. New approaches are developed, and medicine is pushed forward by innovative ways to test newer therapies, modify existing treatments, and eventually improve outcomes for patients with meningiomas. 

1. Investigating New Therapies: 

Preclinical studies document the promise of new therapies and treatment strategies, and clinical trials provide a forum to evaluate them. These might include targeted therapies, immunotherapies, or exploring new combinations of existing modalities. By looking into these cutting-edge interventions, researchers hope to identify ones that show promise for better outcomes or fewer side effects from standard therapies.

2. Personalized Medicine: 

Meningiomas can differ significantly from one another in terms of their features and response to treatment. Clinical trials frequently include approaches to personalized medicine, as treatment decisions can be made differently depending on some particular genetic markers or molecular profiles that are unique to every tumor from that patient. Thus, this results in more precise, effective treatment options that can accommodate every individual's needs.

3. Refining Standard Treatments: 

Clinical trials help refine standard treatments for meningiomas. These trials compare various regimens or optimize the schedule and dose of therapies to help tackle the issue of treatment strategy. Gradual improvements in standard treatments will hopefully yield better outcomes for patients. 

4. Define Mechanisms of Resistance: 

In certain circumstances, meningiomas do become resistant to therapy and grow further. In this respect, examining mechanisms of resistance has been a research area wherein it has been viewed as an opportunity to identify how tumors stop generating responses to therapy. 

5. Identify Combinations of Therapies: 

Combination therapy refers to the combined application of two or more therapies to patients. On the other hand, exploratory clinical trials about the combinatorial effect of therapies include combined surgical and radiation therapy or targeted and immunotherapies. 

6. Keeping a Check on Safety and Side Effects: 

The safety and side effects of investigational treatments are monitored rigorously throughout trials. The very first priority of patient safety is considered, and an assessment of the risk-benefit analysis of the therapies being tested is done on an ongoing basis. Documentation of adverse effects leads to informed changes in dosing and modification so that the patient can be taken care of. 

7. Collaboration and Global Dimensions: 

Clinical trials are a collaboration of researchers, medical centers, and institutions around the globe. With that cooperation, the pace of our research is accelerated and brings to the fold a wide range of patient populations into a given trial to increase generalizability of trial results.

Treatment in India

India's meningioma treatment is internationally acknowledged for a high success percentage, well-developed medical infrastructure, and affordability. Diagnosis in Indian hospitals usually involves an MRI, a CT scan, and oftentimes a biopsy. Once the condition is confirmed, a customized treatment modality is adopted based on tumor size, location, and symptomatology. In general, surgical approaches are preferred as the definitive approach in many instances, particularly where the tumor is accessible and symptomatic. Indian neurosurgical centers offer advanced techniques such as microsurgery, neuronavigation-guided surgery, and minimally invasive surgeries, thereby significantly increasing the odds of a good outcome and a quicker recovery.

Radiation therapy, such as Gamma Knife, CyberKnife, or external beam radiation, is used, for instance, if surgery is not possible or the tumor site is relatively close to important structures. These targeted therapies are very effective in tumor control with minimal possibility of damage to the surrounding normal tissues. If a meningioma is discovered in a small and asymptomatic form, doctors may offer a "wait and watch" approach with regular imaging. During this period of observation, patients may be put on medications; for instance, encouragements to reduce swelling or for anti-seizures.

Leading institutes that specialize in the treatment of meningioma in India are the All India Institute of Medical Sciences (AIIMS) located in New Delhi, Tata Memorial Hospital in Mumbai, Apollo Hospitals in various cities, Fortis Hospital, Medanta-The Medicity of Gurgaon, and NIMHANS in Bangalore, among others. A huge advantage in receiving treatment in India is the reasonable cost criteria, which generally vary between ₹200,000 and ₹500,000 for surgery and ₹250,000 and ₹400,000 for radiosurgery. Services exclusive to international patients are also provided, notably visa assistance, airport pickups, translator services, and personalized medical coordinators. Superb neurosurgeons in India, in alliance with the advance of technology, wholesome care of patients, and cost-effectiveness, have rent-a-cabin for core meningioma treatment in India.