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A very difficult recurrent brain tumour in an elderly woman operated successfully and recovered fully.

About :

Meningiomas are common brain tumours (30% of all primary brain tumours) arise in the peri-menopausal older women. They arise from the meninges or the membranes that surround the brain and the spinal cord. Most meningioma’s (92%) are non-cancerous (Benign) though rarely (8%) a meningioma may be cancerous (malignant/atypical).
Many meningiomas are asymptomatic throughout the person’s life and if discovered, requires no treatment other than periodic observation.
Typically symptomatic Meningiomas like in our patients are treated with either radio surgery or conventional surgery. They tend to reoccur quickly if not totally excised.


History :

A 64 years old OMANI female national was admitted to manipal hospitals-Goa; with no history of injury to the eye, but was operated a year back for a left brain tumor.


Clinically :

A fully conscious, coherent and ambulant patient with proptosis of left eye, outwards and downwards and her visual acuity was 6/18 in left eye and 6/6 in right eye.
She was otherwise neurologically normal.


Diagnosis & Treatment :

A CT scan and MRI of the brain and orbits and the clinical diagnosis of recurrent meningioma with intraorbital extension was confirmed. The tumour was seen extending in to the left infra temporal region laterally and touching the cavernous sinus medially and eroding sphenoid wing and left temporal bone.
After all relevant preoperative investigations and anaesthetic check-up, she was subjected to left pterional craniotomy and the tumour was radically excised and the left orbit was decompressed. PO she made uneventful recovery, her left eyeproptosis regressed totally, her left eye vision returned to 6/6 and headaches totally disappeared. PO CT scan of brain orbits and MRI of brain and orbits showed no residual tumour.


Conclusion :

Recurrent brain tumours occurring in difficult locations of the brain like the sphenoid ridge and invading the surrounding vital structures like cavernous sinus are very difficult cases to operate but, if meticulously planned and carefully operated using the latest neurosurgical operative tools like CUSA, Laser, Microscope and a vascular techniques by preoperative embolization and induced hypotension, such tumours can be operated successfully in well-equipped infrastructure like manipal hospital-Goa.


A case study by : Dr. P. R. K. Prasad
Department of Neurology
Manipal Hospital, Goa

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