Alternative Treatments for Meningioma Surgery Complications: Hydrocephalus Insights

After surgery for a meningioma, if hydrocephalus occurs, are there other treatment options available?

Hello, my mother is 67 years old and started experiencing urinary incontinence, facial drooping, unsteady walking leading to frequent falls, and difficulty swallowing liquids since last year.
After undergoing examinations at the hospital, a 5 cm meningioma was discovered, with no signs of hydrocephalus.
Below is the medical history from July 2009 to January 2010, and I would like to understand if there are other treatment options available that could help my mother recover or prevent further deterioration.
First meningioma surgery (July 2009): The doctor explained during the preoperative assessment that the tumor needed to be removed to a size below 3 cm, after which a stereotactic radiosurgery would be performed.
There was no mention of any potential complications.
Therefore, we proceeded with the surgery to remove the tumor.
However, my mother was unable to open her right eye afterward, and she lost movement in her left hand and leg, requiring the use of adult diapers and assistance for daily activities.
Faced with this outcome, we focused on aggressive rehabilitation and hired a caregiver for support.
After more than a month of rehabilitation, she gradually regained some strength in her left limbs, but still needed assistance to stand and walk.
However, in the following months, her condition continued to deteriorate: her speech became incoherent, her memory declined, and her limbs grew weaker.
We returned to the doctor, and after an MRI, it was discovered that she had developed hydrocephalus.
The doctor explained that a shunt procedure was necessary to relieve the intracranial pressure, which could potentially restore her condition to what it was after the first surgery.
The success rate for the hydrocephalus shunt procedure is very high, with low risks involved.
Second hydrocephalus shunt surgery (January 2010): After this surgery, my mother’s condition worsened further; she lost even more strength in her limbs, required feeding through a nasogastric tube, and remained in a state of drowsiness.
The attending physician explained that the previous tumor had grown larger, around 4 to 5 cm, and was still compressing the brainstem, leading to these symptoms.
He stated that he could not offer any more aggressive treatment options and that my mother’s condition would likely continue to deteriorate, making it impossible for her to walk again.
Our family is truly disheartened by this outcome.
Was the meningioma completely removed during the first surgery? Why does it still measure 5 cm? How did hydrocephalus develop? I would like to ask the doctor if there are any other treatment options available for my mother.

Xiao Li, 40~49 year old female. Ask Date: 2010/02/04

Dr. Ding Xianwei reply Neurosurgery

I sincerely apologize, but without knowing the exact location of the meningioma and the overall condition, I am unable to provide much advice regarding your mother's treatment.
Generally speaking, surgery is the best option for brain tumors when feasible.
However, for certain locations of brain tumors, the surgical intervention may cause significant damage or pose considerable risks.
In such cases, we may perform a decompression surgery followed by radiosurgery.
Based on your description, I suspect that the tumor is located near the brainstem, which could affect cerebrospinal fluid circulation, necessitating a ventriculoperitoneal shunt procedure.
This inherently carries a high risk.
As for the subsequent degeneration, it may be due to the development of hydrocephalus after the gamma knife treatment or could be a natural progression of the tumor.
Given that your mother's symptoms were already quite severe prior to surgery, it is difficult to determine the exact cause of her current condition.
However, medicine often does not yield satisfactory outcomes in many situations.
I recommend that you have a detailed discussion with your mother's attending physician and prepare all necessary information, including imaging studies and all pre- and post-operative data, to seek a second opinion from another neurosurgeon, preferably one with experience in gamma knife treatment, to explore further treatment options.

Reply Date: 2010/02/04

More Info

I'm sorry to hear about your mother's condition. Meningiomas, while often benign, can lead to significant complications, especially when they are large or located in critical areas of the brain. Let's address your concerns regarding alternative treatments and the complications associated with her condition, particularly hydrocephalus.

Firstly, it's essential to understand that meningiomas can cause symptoms based on their size and location. In your mother's case, the 5 cm tumor likely exerted pressure on surrounding brain structures, which could explain her neurological symptoms, such as facial drooping, instability while walking, and swallowing difficulties. The fact that she developed hydrocephalus (accumulation of cerebrospinal fluid in the brain) suggests that the tumor may have obstructed the normal flow of cerebrospinal fluid (CSF), leading to increased intracranial pressure.

Regarding the surgical interventions, the goal of the first surgery would have been to remove as much of the tumor as possible. However, if the tumor was deeply seated or involved critical structures, complete resection might not have been feasible. This could explain why the tumor remained at 5 cm after the initial surgery. The presence of hydrocephalus post-surgery indicates that the tumor's effects on CSF dynamics persisted, necessitating further intervention.

In terms of alternative treatments, there are a few options to consider, although they may not be suitable for every patient:
1. Radiation Therapy: If the tumor cannot be completely removed surgically, radiation therapy (such as stereotactic radiosurgery) can be an effective option to control tumor growth. This treatment targets the tumor with high doses of radiation while sparing surrounding healthy tissue.

2. Chemotherapy: While meningiomas are generally resistant to chemotherapy, some atypical or malignant variants may respond to certain chemotherapeutic agents. This would typically be considered in cases where the tumor is aggressive or recurrent.

3. Clinical Trials: Depending on the specifics of your mother's tumor and overall health, she may be eligible for clinical trials exploring new treatment modalities. These trials can offer access to cutting-edge therapies that are not yet widely available.

4. Supportive Care: Given your mother's current condition, focusing on supportive care is crucial. This includes physical therapy to improve mobility, occupational therapy to assist with daily activities, and speech therapy for communication difficulties. Palliative care can also provide symptom management and improve her quality of life.

It's important to have open discussions with her healthcare team about the prognosis and potential treatment options. If her current medical team is unable to provide further interventions, seeking a second opinion from a specialized neuro-oncologist or a comprehensive cancer center may offer new insights or treatment pathways.

Lastly, regarding the emotional toll this situation has taken on you and your family, consider reaching out to support groups or counseling services. Caring for a loved one with a serious illness can be incredibly challenging, and having a support system can make a significant difference.

In conclusion, while the situation is undoubtedly complex and challenging, there are still avenues to explore for your mother's care. Engaging with her medical team about all possible options, including supportive therapies, is essential in navigating this difficult journey.

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