Expert: Claes-Gustaf Nordquist, M.D. - 7/17/2009

Question
My mother has been suffering from recurring benign brain tumors (meningenoma) since her diagnosis in 1996.  She had her first surgery in 1997.  At that time we were told that there was a possibility that it could recur and they gave us a 10 year window.  Unfortunately it recurred within 7 years.  At that time she had a second surgery.  That was 2003.  Since then it has been awful she has had two cyberknife experience.  The first being actually for one tumor and the second for five different ones.  The second time she had to have it done in three different sessions.  She was told that if the tumor recurred she would be unable to have more radiation.  The last cyberknife session was only a year ago.  They are back and there are three of them.  She does not want to operate again and we feel helpless she is only 62.  Could you explain to us what the process will be like.  Will there be a lot of pain?  I guess theres a lot of fear of the unknown for us at this point. Help!

Answer
This is a question which should be answered by a neurosurgeon (even though the radiological CyberKnife is involved), which I'm not, I'm a medical oncologist and radiation therapist with experience of treating (mainly malignant) brain tumors. More radiation therapy (including ordinary radiation therapy, the CyberKnife & the GammaKnife) is obviously out of the question and she refuses any more surgery. Cases like this are rare but they do happen now & then. Due to the circumstances mentioned above therapy options are extremely limited and her tumors are growing inside her skull which is more or less a closed space. Since they are growing they infringe on that more or less closed space which will cause an increased pressure inside her skull. Her tumors will eventually also due to their growth start pressing on her brain (they are growing from the lining of her brain located around her brain on its outside). What symptoms that will cause depends on where they are located of which I know nothing. The increased pressure will cause head ache, nausea even vomiting. Eventually the increased pressure may threaten the blood circulation inside her skull to her brain. The pressure on her brain from her tumors may also among other things cause epileptic fits. How fast this develops depends on the growth rate of her tumors of which I also know nothing - different for different tumors. Other treatment options are extremely limited - almost non existing. However I was thinking of a technique sometimes used in cases of cancer in the liver and the lungs. The technique is called radio frequency ablation. It is NOT radiation therapy. Instead radio waves are used like in your micro wave oven. The radio waves are directed to the tumor and kills it by heat. Since her tumors are not malignant in a cancer sense this treatment should be at least theoretically possible and could be a possible cure. However I do not know if it is technically possible to do this in her case and with exactly this kind of tumor. Only a neurosurgeon can answer that. But if possible only small holes need to be drilled in her skull  where her tumors are (which should be known by her CT & MRI scans) in order to be able to introduce the radio waves and a necessary needle electrode - I think. Discuss this with a neurosurgeon. If at all possible then this method should be possible to use any number of times also in the future. Good luck!