From the Guidelines
The management of an 11mm meningioma in the left Sylvian fissure in a patient presenting with headache, dizziness, tinnitus, and nausea typically involves a multidisciplinary approach.
Initial Treatment
Initial treatment may include symptomatic relief with:
- acetazolamide 250mg orally twice daily for 2 weeks to alleviate headache and nausea
- meclizine 25mg orally three times daily for 1 week to address dizziness
- gabapentin 300mg orally three times daily for 2 weeks to manage tinnitus, with gradual dose escalation as needed and tolerated 1.
Monitoring and Intervention
Close monitoring with serial MRI scans every 6 months is recommended to assess tumor growth and guide potential surgical or radiosurgical intervention 1.
Key Considerations
- The use of SSTR-directed PET imaging can help differentiate between meningioma recurrence and treatment-induced changes 1.
- PRRT may be considered for patients with meningioma progressing after multiple prior lines of treatment, although it remains an investigational treatment 1.
- A multidisciplinary neuro-oncology board should be involved in the decision to recommend PRRT as an experimental anti-tumor therapy 1.
- The patient should be closely monitored for any changes in symptoms or tumor growth, and adjustments to the treatment plan should be made as needed 1.
From the Research
Management Approach for Meningioma
The management approach for an 11mm meningioma located in the left Sylvian fissure in a patient presenting with headache, dizziness, tinnitus, and nausea is primarily surgical, with the goal of achieving gross total resection 2.
Treatment Options
- Surgical resection is the mainstay of treatment for most symptomatic meningiomas, including those located in the Sylvian fissure region 3.
- Radiosurgery is preferred as first-line treatment in small, enclosed, pauci-symptomatic lesions or in elderly patients, while large meningiomas not amenable to resection or WHO grade II-III are candidates for radiotherapy 4.
- Systemic oncological therapy, including tyrosine kinase inhibitors and immunotherapy, may be considered in cases where surgery and radiotherapy are not feasible or have failed 5, 6.
Considerations for Sylvian Fissure Meningiomas
- Meningiomas in the Sylvian fissure region without dural attachment are rare and may present with complex partial seizures, as seen in a series of three patients reported in the literature 2.
- The treatment of these tumors requires a multidisciplinary approach, including experienced skull-base neurosurgeons, radiation oncologists, radiologists, ophthalmologists, and endocrinologists 4.