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Neurology (Expert Forum)
SRT vs Wait and See
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SRT vs Wait and See
by jackaroo2, Sep 03, 2005 12:00AM
49 year old male with MRI/CT Diagnosis of R Planum Meningioma, tumor appears to have a tail that extends into the optic nerve canal. Boderline outcomes of vision screening indicate questionable optic nerve impingement/involvement at this time.
We have consulted with Doctors at Jefferson and Penn.
Jefferson Tumor Board Doctors
Outcome: recommendation 6 weeks of SRT.
Penn Doctors said wait until the optic nerve is impaired before doing anything, come back in 6 months time or sooner if sympathmatic.
WHAT do we do? See another Neurosurgeon?
The Jefferson physicians seemed very concerned, as did the Neuro Opthalmologist at Wills Eye who sent us there.
The Penn doctors seemed unimpressed and not concerned at all?
Please advise.
*Incidentially, my sister was Diagnosed in April 05 with Glioblastoma Multiforum, is this a coincidence or is my family predisposed to Brain Tumors? Could mine be cancerous and not the ASSUMED benign? (We are told a biopsy of a tumor in this area is not fesiable)
We have consulted with Doctors at Jefferson and Penn.
Jefferson Tumor Board Doctors
Outcome: recommendation 6 weeks of SRT.
Penn Doctors said wait until the optic nerve is impaired before doing anything, come back in 6 months time or sooner if sympathmatic.
WHAT do we do? See another Neurosurgeon?
The Jefferson physicians seemed very concerned, as did the Neuro Opthalmologist at Wills Eye who sent us there.
The Penn doctors seemed unimpressed and not concerned at all?
Please advise.
*Incidentially, my sister was Diagnosed in April 05 with Glioblastoma Multiforum, is this a coincidence or is my family predisposed to Brain Tumors? Could mine be cancerous and not the ASSUMED benign? (We are told a biopsy of a tumor in this area is not fesiable)
Doctor's Answer
by CCF-Neuro-M.D.-PW, Sep 08, 2005 12:00AM
You have been seen by two good centers, so I cannot rebuff either opinion when I cannot evaluate you over the internet
I'm not sure what 'visual screening' entailed - there should be a formal ophtlamologic examination, visual fields, direct fundoscopy etc. Radiotherapy is the treatment of choice for surgically inaccessable meningiomas, and at least one series has shown that radiotherapy in most cases does not adversly affect visual function. To treat or not to treat is controversial though, although progrossive imapirment of vision would warrant treatment. The tumor is usually slow growing and MRI/visual testing can be followed over time to detect growth or worseging, it may eventually require treatment though over time. The vast majority of meningiomas are benign, especially if they do not change much on MRI over time.
Some gentetic mutations have been found that predispose to brain tumors of certain types, it may be worth being evaluated for neurofibromatosis type 2, but otherwise no other genetic testing would be indicated or is available.
I'm not sure what 'visual screening' entailed - there should be a formal ophtlamologic examination, visual fields, direct fundoscopy etc. Radiotherapy is the treatment of choice for surgically inaccessable meningiomas, and at least one series has shown that radiotherapy in most cases does not adversly affect visual function. To treat or not to treat is controversial though, although progrossive imapirment of vision would warrant treatment. The tumor is usually slow growing and MRI/visual testing can be followed over time to detect growth or worseging, it may eventually require treatment though over time. The vast majority of meningiomas are benign, especially if they do not change much on MRI over time.
Some gentetic mutations have been found that predispose to brain tumors of certain types, it may be worth being evaluated for neurofibromatosis type 2, but otherwise no other genetic testing would be indicated or is available.