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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What do the following MRI reports indicate?

Answered by
Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3389 Questions

Posted on Mon, 2 Nov 2015 in Headache and Migraines
Question: I had a craneotomy on 4/29/15, after biopsy it was revealed that it was an Atypical meningioma.About 2 wks. ago i sent a question about encephalomalacia and neurologist Olsi Taka answered. I was satisfied with his answer. but i had another MRI done on 10/13/15. The radiologist that read the MRI done on 8/13/15 didn't mention anything about remnant of tumor but she mentioned the encephalomalacia. The one on mri done 6/5/15 mentions remnant and again the radiologist for MRI done on 10/13/15, mentions remnant and that it grew. as you can see not all radiologists see the same thing and not all neurosurgeons perform the same craneotomies to total satisfaction of pt. My Question can an experienced and knowledgeable neurosurgeon access my remnant tumor through my nose, or go/cut above my right eyebrow and get to remnant of tumor? I am attaching the 3 MRIs, so you can have a clear picture of my situation and if i decide for further surgeries would you recommend the Mayo clinic in MN. or do I for the cyberknife? please be as honest as you can be and I hope you can explain/help as well as Dr. Taka. Thanks
Answered by Dr. Erion Spaho 2 hours later
Brief Answer:
Meningioma is best treated by craniotomy.

Detailed Answer:
Hello and thanks for using HCM.

I have read your question and understand your concerns.

I examinated the MRI reports you uploaded too.

First, you shouldn't worry about encephalomalatia, it means more or less "softening" of brain tissue and it is a common finding after brain surgery, among other causes.

Radiologysts in the first two reports mention thickening of dura or remnants, but don't mention any clear evidence about tumoral recidue, in the third and comparable report there is residual tumor reported.

Tumor recidue is very probable with atypical Meningioma and close follow up needed.

It is important to know exactly the grade of the Meningioma. Atypical Meningioma can be a grade II WHO, a intermediate one regarding to malignity, can be a grade III WHO, a malignant one.

Treatment choice about Meningioma is almost always surgical excision through craniotomy and in atypical Meningioma as more radical as possible.

Endoscopic approach also is not the first choice in treating Meningioma.

Cyberknife is reserved for cases with contraindications to surgery, or if the tumor is inaccessible through surgery.

Craniotomy is chosen by the Neurosugeon.

Hope you found the answer helpful.

Let me know if I can assist you further.

Take care.

Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Erion Spaho 9 hours later
Dr. Spaho, In your opinion you recommend a 2nd. craniotomy would the neurosurgeon cut again on the same place/scar where the 1st. craniotomy was done? And what about the gliosis that is mentioned in the MRI done 10/13/15. are there any treatments/medicines (conventional or unconventional) that can help with encephalomalacia or the "mild gliosis" that is mentioned on MRI done 10/13/15? Or my last option can I just wait maybe another 6 months or so and see how much (or if it does) the remnant of tumor grows and that would help me for the 1st craniotomy to heal because the site of the cut still hurts and is still tender to touch? Again please give me your honest/professional opinion and if you can, please think of my case like it was a family member of you who is asking you these questions. And again if I decide for surgery would you recommend the Mayo Clinic in MN. Thanks
Answered by Dr. Erion Spaho 18 hours later
Brief Answer:
Situation can wait few months.

Detailed Answer:
Welcome back and thanks for being on follow up.

As I mentioned before, surgery (craniotomy) is the most acceptable today about Meningioma treatment, with few cases with contraindications to surgery treated with other methods.

The choice of craniotomy is of your Neurosugeon, there are criteria that should be evaluated before deciding.

If it is reasonable, first craniotomy should be used.

The surgical procedure also is recommended regarding to size of the lesion, increase rate and symptoms it may cause.

In your case, in my opinion, a MRI after three months could be appropriate.

Encephalomalatia and gliosis are common findings after neurosurgical interventions, there is no specific treatment about them, and if there are no symptoms related such seizures eg. you shouldn't worry about.

About Mayo clinic, what I heard it is through the best neurologic institutions, so, if it is possible, having a evaluation there is a good thing about your condition.

Hope I helped you.

Best regards.

Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Erion Spaho 5 hours later
Thanks Dr. Spaho, thank u very much for your answers. next i will close discussion and give u a review.
Answered by Dr. Erion Spaho 28 minutes later
Brief Answer:
You are welcome.

Detailed Answer:
Glad I helped you.

Wishing you good health.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar

The User accepted the expert's answer

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