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    Case Study

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    This case study describes a 32-year-old female diagnosed with a left sphenoid wing meningioma. She presented with various neurological symptoms including headaches, vision changes, and behavioral issues. Imaging revealed an expansive tumor on her left sphenoid wing. She underwent two craniotomies for tumor resection but it recurred. Pathology indicated the tumor was a WHO Grade II meningioma. She received post-operative radiation therapy to the left base of skull. Her treatment plan aimed to deliver 5220 cGy over 29 fractions to control the tumor while sparing nearby critical structures. She may experience side effects from treatment but surgery and radiation provide the best chance for control of this type of tumor.

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    Case Study

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    414 views27 pages
    This case study describes a 32-year-old female diagnosed with a left sphenoid wing meningioma. She presented with various neurological symptoms including headaches, vision changes, and behavioral issues. Imaging revealed an expansive tumor on her left sphenoid wing. She underwent two craniotomies for tumor resection but it recurred. Pathology indicated the tumor was a WHO Grade II meningioma. She received post-operative radiation therapy to the left base of skull. Her treatment plan aimed to deliver 5220 cGy over 29 fractions to control the tumor while sparing nearby critical structures. She may experience side effects from treatment but surgery and radiation provide the best chance for control of this type of tumor.

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    This case study describes a 32-year-old female diagnosed with a left sphenoid wing meningioma. She presented with various neurological symptoms including headaches, vision changes, and behavioral issues. Imaging revealed an expansive tumor on her left sphenoid wing. She underwent two craniotomies for tumor resection but it recurred. Pathology indicated the tumor was a WHO Grade II meningioma. She received post-operative radiation therapy to the left base of skull. Her treatment plan aimed to deliver 5220 cGy over 29 fractions to control the tumor while sparing nearby critical structures. She may experience side effects from treatment but surgery and radiation provide the best chance for control of this type of tumor.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    414 views27 pages

    Case Study

    Uploaded by

    api-313356122
    This case study describes a 32-year-old female diagnosed with a left sphenoid wing meningioma. She presented with various neurological symptoms including headaches, vision changes, and behavioral issues. Imaging revealed an expansive tumor on her left sphenoid wing. She underwent two craniotomies for tumor resection but it recurred. Pathology indicated the tumor was a WHO Grade II meningioma. She received post-operative radiation therapy to the left base of skull. Her treatment plan aimed to deliver 5220 cGy over 29 fractions to control the tumor while sparing nearby critical structures. She may experience side effects from treatment but surgery and radiation provide the best chance for control of this type of tumor.

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    © All Rights Reserved
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    of 27

    Case Study

    CNS CANCER - MENINGIOMA


    -Courtney Chaney

    Patient Information
    White
    32

    Female

    Years of Age

    Social History

    Married, Mother of one

    Works in finance

    Never Smoked

    Socially Drinks

    Breastfeeding

    Medical History

    Recent Child Birth

    Dysmenorrhea

    Meningioma

    Family History

    Asthma

    Allergic to Codeine

    Breast Cancer (mom,


    aunt)

    -tested for carrier but was


    negative

    Prostate Cancer

    Hypertension

    diabetes

    Surgical History

    MANDIBLE FRACTURE SURGERY

    ADENOIDECTOMY

    APPROACH CRANIAL FOSSA ANTERIOR


    ORBITOCRANIAL

    EXCISION LESION CRANIAL FOSSA MIDDLE


    INTRADURAL

    EXCISION LESION CRANIAL FOSSA ANTERIOR


    EXTRADURAL

    CRANIOPLASTY FOR SKULL DEFECT

    ASSISTANCE STEREOTACTIC NAVIGATION


    CRANIAL INTRADURAL ADD-ON PX

    EXCISION BONE TUMOR CRANIAL W/ OR


    W/O OPTIC NERVE DECOMPRESSION

    EXCISION BRAIN TUMOR INTRACRANIAL


    TRANSNASAL APPROACH
    NEUROENDOSCOPIC

    ASSISTANCE STEREOTACTIC NAVIGATION CRANIAL EXTRADURAL ADD-ON


    PX
    EXCISION BRAIN TUMOR INTRACRANIAL TRANSNASAL APPROACH
    NEUROENDOSCOPIC

    ASSISTANCE STEREOTACTIC NAVIGATION CRANIAL EXTRADURAL ADD-ON


    PX
    INTRAUTERINE DEVICE INSERTION

    CESAREAN SECTION DELIVERY

    CESAREAN APPROACH

    CRANIAL FOSSA ANTERIOR ORBITOCRANIAL

    EXCISION LESION CRANIAL FOSSA MIDDLE INTRADURAL

    ASSISTANCE STEREOTACTIC NAVIGATION CRANIAL INTRADURAL ADD-ON


    PX

    Presenting Signs & Symptoms


    Localized headaches

    Blindness of left eye Jan 2015

    Proptosis 2013

    Chronic rhinitis Dec 2014

    Seizures
    Hyperostosis - 2013

    Behavioral changes

    Personality changes

    Ptosis Dec 2013

    Blurry vision - 2013

    Diplopia - Dec 2014

    Speech pattern changes

    Coordination skills changes

    Vision abnormalities - Dec 2014

    Mental changes

    Nausea & vomiting Jun 2013

    Motor skill changes


    Vertigo Jun 2013

    Sensory Function Changes

    Orbital CT showed expansive tumor on left sphenoid wing

    Edema cerebral -2015

    Reflex changes

    ICP symptoms

    Papilledema

    Defective memory

    Aphasia

    Pathology

    Malignant neoplasms of the cerebral meninges


    - typically happens in the dura mater

    left greater sphenoid wing intraosseous meningioma involving the cavernous


    sinus about 20 % of meningiomas are sphenoid wing meningiomas

    Anatomy & Physiology

    Meninges are the protective outer


    covering of the brain

    Meninges are Dura Mater, Arachnoid,


    Pia Mater

    Dura Mater- hard

    Arachnoid-

    Pia Mater- adheres directly to the


    brain

    Brian is made up of 6 lobes and sits


    in the skull

    The greater wing of the sphenoid


    helps create the cranial fossa of the
    skull

    No lymph nodes in the brain

    Epidemiology

    1.5% of all malignancies are in the brain

    1/3 of all CNS are meningioma

    5.2 our of 100,000 people in the population a year

    Most CNS CA effects patients 50-80 yr. olds

    Meningiomas affect more women than men, 2:1


    -Atypical and anaplastic meningiomas show a male predominance
    -Childhood meningiomas occur more often in males

    Meningiomas associated withneurofibromatosis type 2(NF2) tend to occur in


    younger individuals

    meningiomas are rather uncommon in children and almost never occur in infants

    Etiology

    Ionizing Radiation

    Head Injury

    Hormones (Estrogen & Progestogen)

    Dental Radiographic exams

    Occupational exposure
    - healthcare workers & health care workers show higher incidence

    Environmental Exposure

    Lifestyle and Dietary Factors


    - cell phones, nitrates, hair dye, and smoking

    Genetic Factors (>5% of etiology of brain tumors)

    Recklinghausens disease and autosomal dominant disorders (NF2)

    Family has history

    Histopathology

    Anaplastic Meningioma & Atypical Meningiomas - >10%

    WHO grade I includes the following histologic patterns:

    Meningothelial (syncytial) meningioma

    Transitional (mixed) meningioma

    Fibroblastic (fibrous) meningioma

    Psammomatous meningioma

    Angiomatous (vascular) meningioma

    Microcystic meningioma

    Secretory meningioma

    Lymphoplasmacyte-rich meningioma

    Metaplastic meningioma

    WHO grade II includes the following histologic patterns: Chordoid meningioma

    Clear cell meningioma (intracranial) (showing signs of this now)

    Atypical meningioma

    WHO grade III includes the following histologic patterns:

    Papillary meningioma

    Rhabdoid meningioma

    Anaplastic (malignant) meningioma

    WHO Grading System

    Grade I Benign meningioma: This non-cancerous type of brain tumor grows


    slowly and has distinct borders. Approximately 78-81% of meningiomas are
    benign (non-cancerous).

    Grade II Atypical meningioma: Approximately 15-20% of meningiomas are


    atypical, meaning that the tumor cells do not appear typical or normal.
    Atypical meningiomas are neither malignant (cancerous) nor benign, but may
    become malignant. Grade II atypical meningiomas also tend to recur and grow
    faster.

    Grade III Malignant or anaplastic meningioma: Malignant or anaplastic


    meningioma is an aggressive type of brain tumor that tends to invade the
    parts of the brain nearest to the tumor. Approximately 1-4% of meningiomas
    are grade III (cancerous).

    Patient Grading & Staging

    Grade 1 on WHO Grading System

    On recent biopsy though Cells have mucinous, myxoid or vaguely chordoid pattern
    and even occasional PAS-positive clear cells

    cannot be classified histologically as a specific WHO


    grade II variant, the clinical behavior, elevated Ki-67 labeling index and
    partial clear cell and chordoid features suggest a WHO grade II lesion

    No universal staging system

    Imaging

    Orbit CT revealed initial tumor

    Head CT

    Brain MRI confirmed meningioma and placement

    Head CTA

    Craniotomy (LEFT ORBITO-FRONTO-TEMPORAL CRANIOTOMY FOR RESECTION


    OF A SPHENOID WING MENINGIOMA)
    - tumor reoccurred and had second craniotomy

    Biopsy

    CT Simulation Plan Treatment

    Treatment Options

    Surgery Subtotal resection or Gross total resection

    Radiation Therapy- Post Op (after 2nd surgery) 54-59 Gy


    -if after gross total resection 6000 GY
    - stereotactic or external beam

    Chemotherapy Not Recommended

    Treatment Plan

    Lt. Base of Skull

    4-field V-Mat

    6MV

    Prescription of 5220 cGy

    29 Fx

    180 cGy/day

    Treatment Plan

    Treatment Plan Parameters

    Supine, head first

    Brain Lab aquaplast mask

    Headrest C

    Hands on Chest

    2mm shims

    2mm clips

    Conformal board

    MLCs

    Treatment Borders

    Based upon location and size of tumor

    Try to block as much healthy tissue as you can while still effectively treating

    Dose Distribution

    Dose Distribution

    DRRs

    Critical Structure (cGy)

    Optic Chiasm 5000

    Optic Nerve 5000

    Brain 4700

    Lt. Parotid Gland - 3200


    Brian Stem - 5000

    Retinas 4500

    Spinal Cord- 4700

    Ears 3000 or 5500

    Eyes 1000

    Lens - 1000

    TMJ joint & Mandible 6000

    Lacriminal Gland - 2600

    Side Effects

    ACUTE

    -hair loss, fatigue, skin erythema, headaches, nausea, brain swelling, speech
    problems, muscle weakness, vision problems
    -Medicine can be given for headaches and nausea
    - Corticosteroids or steroids
    - less strenuous activities and naps for fatigue

    CHRONIC

    - reoccurrence, decreased intellect, memory impairment, confusion,


    personality changes, alteration of normal function

    Prognosis and Survival

    Survival rates for meningioma depend on several factors, including the age of
    the patient and whether the tumor is cancerous

    93.1% of benign meningiomas, 65.4% of atypical meningiomas, and 27.3% of


    malignant meningiomas were cured by surgery

    Metastatic Sites

    Meningioma very rarely spreads to other parts of the body

    If they do, lung is the most common followed by the abdominal viscera,
    bones, and lymph nodes

    References

    1. IHIS

    2. Aria

    3. Notes

    4. John Hopkins University and Health Staff. Treatment for Meningiomas.


    2014. February 26, 2015. http://www.hopkinsmedicine.org/

    5. Fung, K. (2014, April 21). Meningiomas Pathology (A. Adesina, Ed.).


    February 26, 2015. http://emedicine.medscape.com/

    6. Washington, C. (2010). Central Nervous System Tumors.Principles and


    practice of radiation therapy(3rd ed.). St. Louis, Mo.: Mosby Elsevier.

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