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May 13th, 2011
02:00 PM ET

Gupta: Waiting out a meningioma

All the news about one of my favorite actresses, Mary Tyler Moore, reminded me of the first time I saw a patient with a meningioma. It was 1995. I was a junior neurosurgery resident, and my professor introduced me to a 69-year-old, perfectly healthy appearing woman. That surprised me at the time, because moments earlier, I had been reviewing her MRI scan. She had an obvious bright mass in her brain located in the right frontal lobe.

I carefully examined the movements of her eyes and face. I checked her motor strength and sensation in her four extremities and completed a full neurological exam. Her long-term memory and instant recall were intact, and she did not complain of headaches. “I wouldn’t even know it is up there,” she said, referring to her brain tumor.

This pleasant woman had been showing up at the clinic for several years, with a scan in hand to review with my professor. If the mass looked no different, and more importantly, if the patient didn’t have any neurological changes – they would simply make a date to see each other again in another year, and repeat the process. They had collectively agreed to not operate on the obvious brain tumor, but instead to watch, wait, and bank on the possibility she would never need an operation in her lifetime.

That may sound surprising, given we are talking about brain tumors. Truth is, while there are many types of brain tumors that do require urgent operations, meningiomas are often treated differently. They have such a characteristic appearance on an MRI scan, there is often little doubt when you see one. And, about nine out of 10 times, they are benign. If the tumor is relatively small, the patient is not very young, and there are no symptoms – the neurosurgeon is likely to offer the “watchful waiting” as an option.

Two years later, we did operate on the then-71-year-old woman. Her most recent scan had shown a sudden growth in the size of the mass. Worried that it might continue growing at an accelerating rate, my professor and the patient collectively agreed an operation was the best course of action.

There are other things that may have tipped the scale toward an operation. If the mass had changed in its appearance, and looked more malignant. And, of course, if our patient had started to have any symptoms such as blurriness of vision, seizures, headaches or weakness, to name a few.

These are the types of conversations and considerations Mary Tyler Moore has likely been having with her doctors over the past few years, now deciding an operation was prudent for possibly one of these reasons. By the time you read this, Ms. Moore may have already had the brain surgery necessary to remove the tumor, and may even be scheduled for radiation treatment, which is sometimes necessary if all the tumor cannot be removed. Here is wishing her a speedy recovery.

Each week, CNN’s Dr. Sanjay Gupta, also a practicing neurosurgeon, posts a “medical mystery” photo from inside his operating room on Twitter. Follow @SanjayGuptaCNN and tweet Dr. Gupta your best guess!


soundoff (89 Responses)
  1. Robin

    I was trying to say and misspelled ...I am Wishing the Best for Mary Tyler moore.....

    Thank you, Robin

    May 16, 2011 at 21:38 | Report abuse | Reply
    • teresa

      ADULT STEM CELLS CURE'S AIDS / HIV and A NUMBER OF OTHER THINGS BUT WHY????? IS AMERICA BEING HELD BACK FROM THE MAJOR LEAP IN MEDICINE DOES AMERICA WANT TOO KILL YOU ??????? OTHER COUNTRIES MAKING MAJOR LEAPS INTO MEDICINE BUT AMERICA IS STILL IN THE STONE AGE WHY????? WHO BENEFITS THE FDA BIG CORPORATIONS .......???

      October 17, 2011 at 22:19 | Report abuse |
  2. Jody

    Strongly wishing Mary Tyler Moore well.

    I was dx'd with a spinal cord meningioma (way high in the neck, at C-1 - the first spinal cord vertebra). It was accidentally found on an MRI for painful signs of disk damage in lower neck disks.

    This was around the time of 9/11, and I thought some of my "minor" symptoms were just stress - slight numbness in part of my face; very slight stress incontinence; most notably, a couple of minor falls or trips crossing a street or going up stairs; a slight sense of foot drop in one foot. It all made sense after the MRI.

    I was also offered "watchful waiting," but the symptoms were real (though mild). I asked two candidate neurosurgeons: Would you want your spouse or sister operated on at this point, if they had "my" meningioma and subtle symptoms, at age 50? They both said "Yes." That was all I needed to hear.

    I asked one of the surgeons: "Am I likely to be able to ride my moped after the operation?" (This was a not-very-subtle probe, really meaning, "Do you think I'll be okay?") He deadpanned to my husband, big twinkle in his eye, "How much will you pay me to say she can't ride her moped any more?" I did continue to ride, after I recovered from the surgery!

    I think "watchful waiting" would have been for more stressful for me than "having it out." But clearly, this is an individual taste, and partly related to the already-present (but mild) symptoms. So I had it out.

    Apparently, "We got it all" (which is what my surgeon said) means there is about an 85% chance it won't come back. Except for the occasional foot drop when I am tired, all the other symptoms resolved. I don't obsess about the 15% chance of recurrence, and only get a followup MRI every few years, less often than the insurance company allows.

    It is amazing that such a terrifying diagnosis did not cause far more psychological upheaval than it did. I attribute this to the wonderful support of family, doctors, and the ability to do my own research on the internet, to validate what I was being told.

    My thoughts are with "MTM" and all others facing this scary - but not as bad as an astrocytoma or glioblastoma - diagnosis. Be a full partner with your doc and family; tell them what you want, what you fear, and what you want to know, every step of the way. Good luck, "MTM", and thank you so much for all the entertainment pleasure you have given to so many for such a long time.

    May 16, 2011 at 23:39 | Report abuse | Reply
  3. Bob

    Dr. Gupta:
    Is microsphere embolizationfor benign meningioma an option? Some work done in Germany many years ago. May offer an option that makes surgery easier or perhaps avoid surgery.

    Bob

    May 16, 2011 at 23:43 | Report abuse | Reply
  4. Dano

    Not having definitive answers about Meningiomas in my opinion is a crime. An emotional, mental and phyisical crime on those who suffer from them. Dear media,..stop minimizing the affects of Meningiomas. Any brain tumor which requires vascular blood flow is "alive" and should NOT be in, on, or near the brain. Why is it Meningiomas are considered less threatening when it feeds off the human life source? It is similar to a parasite living off it's host. It is a foregin "mass" and deserves the full and ACCURATE attention from ALL media outlets and government funding for research. It is just as dangerous as any other type of brain tumor. Wishing MTM all the very best. Praying for a speedy and uneventful recovery.

    May 17, 2011 at 13:02 | Report abuse | Reply
  5. Billy

    I had a menigioma removed via craniotomy 5 months ago after 4 years of monitoring (after 3 years of inactivity, the tumor doubled in size in a short period of time and was headed for the ocular chiasm). I am truly blessed – it is as though nothing ever happened and I was back at work fewer than 2 months after the surgery with no side affects other than a wicked scar under my hairline.

    There is no overstating the fear that comes with the discovery of a brain tumor, and the issue strikes young and old alike (I was 27 when I was diagnosed). As much as I was told it was the "good" kind of brain tumor (and it was, no doubt about that), it doesn't change the fact that this is a life-altering and frightening experience. I wish MTM the best and know the prayers she will be receiving will help as they did with me.

    May 17, 2011 at 21:00 | Report abuse | Reply
    • Donna

      I was diagnosed with a meningioma in March of his year and had it removed April 4. I suffered a slight stroke during the surgery that weakened my left side. I did 2 weeks rehab therapy and now am back at home. Now I just need radiation treatmennts to remove the 15% that was unable to be removed. It's been an amnzing journey. I'm finding more and more people who have his. Within a week of discovering I had this diagnosis, I met 2 women who recently had theirs removed 6 months prior.

      May 15, 2012 at 12:22 | Report abuse |
  6. Steve

    On Easter Sunday of this year, just before daybreak, I was awoke by what sounded like my 17 year old son hyperventilating. I went to his bedroom to try and wake him up because I thought he was having a bad dream. He wouldn't wake up. To make a long story short, he was having a seizure. I did not know it at the time. He had never had one before, and he is the picture of health. The paramedics took him to the hospital where he was given a CT scan, X-ray and MRI. They found a cavernous hemangioma. I don't know the difference between that and a meningioma, but don't think either are good. My son has been told by the neurologists at the Cleveland Clinic that he must have this removed because it has bled significantly. He is scared, as you can imagine, as am I and his mother. Such a good kid. I want to thank every one that had the courage to deal with your situation and I pray for you all and would ask that you also pray for my son, Anthony. He is such a good, respectful young man, and I can't bear the thought of anything bad happening to him. All he wants to do is drive a car, which we were going to do shortly, but in Ohio, you cannot drive for 6 months once you have seizure. But that is really the least of our worries right now. Thanks again and God bless you all!

    May 19, 2011 at 22:38 | Report abuse | Reply
  7. george atkins

    WHY EVERY TIME THERE IS A HEAT WAVE I NEVER HEIR OF ANYONE ON THE NEWS JUST TELLING PEOPLE WHO ARE OVER HEATING DO TO THE HEAT , TO FILL A BATH TUBE UP WITH WATER AND USING THE HYPOTHERMIC ACTION OF WATER TO HELP ?

    July 20, 2011 at 08:06 | Report abuse | Reply
  8. Mia

    Dear Dr. Gupta,
    I was saddened to read about MTM meningioma back in May. The news read that she was having a "routine" operation. I, too, had a craniotomy to remove a meningioma a little over a year ago. Although understand from the medical professional perspective, this operation is routine. From the patience perspective it is anything but. It has been life altering but not necessarily in a bad way. Although I still suffer from headaches and fatigue, it has given me the courage to take risk and make changes in my life. I consider myself one of the lucky ones. So routine for some is life altering for others.

    July 21, 2011 at 18:40 | Report abuse | Reply
  9. teresa

    ADULT STEM CELLS CURE'S AIDS / HIV and A NUMBER OF OTHER THINGS BUT WHY????? IS AMERICA BEING HELD BACK FROM THE MAJOR LEAP IN MEDICINE DOES AMERICA WANT TOO KILL YOU ??????? OTHER COUNTRIES MAKING MAJOR LEAPS INTO MEDICINE BUT AMERICA IS STILL IN THE STONE AGE WHY????? WHO BENEFITS THE FDA BIG CORPORATIONS .......?

    October 17, 2011 at 22:19 | Report abuse | Reply
  10. Lily Lara

    I have a right frontal meningioma the size of a marble. I am 50 years old and suddenly started having seizures and weakness in the left side and double vision on my right eye. I have been to several doctors and one has diagnosed me with PNES which means I am having "pseudo" seizures. My husband tells me I am getting them while I sleep. Could this meningioma be causing these seizures? I am not on any anti-seizure medication. I would appreciate any input.

    October 30, 2012 at 15:56 | Report abuse | Reply
  11. Robbin Goal

    Normally I do not learn post on blogs, but I wish to say that this write-up very pressured me to try and do it! Your writing style has been amazed me. Thank you, very nice post. Robbin Goal http://www.robinhoodchina.info

    January 31, 2013 at 05:08 | Report abuse | Reply
  12. Alona Combest

    Brain surgery may be carried out due to various varying reasons. The most notable reason why brain surgery procedure is carried out is due to the growth of tumors in the brain. Brain tumor leads to complications such as memory loss and in most cases death. Though brain tumor is operable there are some tumors that are literally inoperable due to their extensive growth. Other than brain surgery, removal of tumors from the brain can be done through chemotherapy. This is however recommended for cancer patients. Other reasons that can facilitate brain surgery include brain hemorrhage and severe head injuries. :

    Remember to find out more about our own web-site
    <http://www.healthmedicinecentral.com/pain-behind-eye/

    February 11, 2013 at 09:02 | Report abuse | Reply
  13. Roman Bartolo

    Microsurgery is utilized in many aspects of neurological surgery. Microvascular anastomosis are required when EC-IC surgery is performed. The clipping of aneurysms is performed using a microscope. Minimally invasive spine surgery utilizes these techniques. Procedures such as microdiscectomy, laminectomy, and artificial discs rely on microsurgery.',',

    Our own blog site
    <http://www.healthmedicinejournal.com

    June 10, 2013 at 01:23 | Report abuse | Reply
  14. Ladonna Cutty

    Patients with intraparenchymal bleeds have symptoms that correspond to the functions controlled by the area of the brain that is damaged by the bleed...'^

    Most recent article produced by our personal homepage
    <http://healthfitnessbook.com/

    June 10, 2013 at 01:53 | Report abuse | Reply
  15. JHrncir

    Can exposure to ionizing radiation result in the development of a meningioma tumor? If so, can this tumor possibly start a growth period let's say for 30 years prior to its detection? What are some of the employment areas that would be high risk for this type of tumor to develop other than medical fields?

    September 16, 2013 at 03:10 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.