Live with a meningioma
Responses by Pr Hugues Loiseau, neurosurgeon, to patient questions
In the absence of serious clinical signs, how should you be organized as a precaution so that the presence of meningiomas is easily known to help? (Ex: Keeping the CD of your MRI on yourself? A paper copy? Registering on a list with SAMU (exists for cardiac pathologies))
I am one of the unpaid because "asymptomatic" is: fatigue, dizziness (finished from the stop of the Androcur and a small decrease in size of the large meningioma in the 5- and above all a decrease in brain edema).
Hugues Loiseau, professor of neurosurgery at the Bordeaux University Hospital : in my opinion not. The only (low) risk would be to make an epilepsy crisis.
What drugs are contraindicated in case of meningiomas? If not the progestins of course!
HL: Those with anti-Androgenic activity, like some diuretics (Spironolactone for example).
Hello I do not know if a neurosurgeon can answer this question. What is happening in our brains is complicated between chemistry, meningioma, emotional ... Is my question: can Lyrica induce depressive states and if so can it be replaced by another molecule?
HL: Regarding the Lyrica, it is indicated side effects such as suicidal ideas (see adverse effects).
An inflammation linked to radiochurgery on a meningioma includes on the nerve of the trigeminal causing predominant neuropathic pain in the territory of the right V 1 can be absorbed over time?
HL: It all depends on the duration after radiosurgery. There are quite many therapeutic options concerning neuropathic pain.
Does edema that develop around meningioma regresses at the same time as meningioma? What is the impact of edema?
HL: Yes, edema must be absorbed. Brain edema can cause epilepsy attacks, although this is rare.
When you stop all progestin, how long does it take to decrease meningioma? At what rate? Does he regress at the same speed he has grown?
HL: Meningiomas decrease by around 30% in the first 6 months, in the vast majority of cases. We don't know very well how fast they get bigger.
Furthermore, is the progesterone that we naturally produce influence the evolution of meningioma?
HL: In my opinion no.
When we talk about meningioma we talk about tumor that starts from the meninges if I understood correctly. There where I do not understand it is how then is it that this tumor can infiltrate or include a trigler nerve. This is my case. Does that mean that it completely penetrates the nerve. Thank you in advance.
HL: The relationships between the tumor and the trijumeau nerve are variable. It can be considerably distorted and therefore injured by the tumor.
Pain - Scars - Fatigue
What exactly happens and in understandable terms, at the scar level so that it is bad more than two years after still on the scalp. I still haven't really understood the explanations.
HL: A skin incision leads to the section of small nerve fibers conveying the sensitivity of the scalp. Their regrowth often leads to bizarre sensations that are sometimes unpleasant that decrease over time.
In the brain, where the tumor was, is it water that stays instead? Does this lead to an imbalance that causes these residual vertigo?
HL: Nature horrifying the void, the volume released by the Méningioma excision is filled, on the one hand by the brain which "returns to its place" and by the liquid which surrounds the brain ( cerebrous liquid).
Why do we keep fatigue for so many years?
HL: Getting to say that you have a tumor in your head is meaningful, consumes a lot of mental resources and can be accompanied by depressive symptoms whose fatigue can be part.
There are also unpleasant pain in the 2 scars that I have on the skull, loss of memory and balance. Do neurological pain (hypersensitivity, feeling of teeth for example) ended, does the brain stop sending the pain message one day?
HL: Yes, in the vast majority of cases
Evolution of the Sequelles
Suffering from neuropathic pain following a paresthesia left leg consecutive to the excision of a meningioma two and a half years ago can I still hope for a favorable evolution and see the neuropathic pain disappear?
HL: Yes, especially since there are several treatment options for such pain.
Can we observe a personality change due to meningioma whatever its positioning or only in certain very specific locations? I have just sought, and indeed: "frontal lobe - these are the high functions, memory, judgment. The tumors of the frontal lobe can cause changes in personality, speech difficulties".
HL: Yes, of course! The announcement of a brain tumor inflects the course of life.
Meningiomas and Androcur
Statistically in the case of “Androcur” meningomes, how much decrease the treatment of treatment, and how many continue to grow?
After how long, do we know if it decreases or not?
HL: The vast majority, but there is also a question of location. Under these conditions, a low percentage (but not zero) continues to grow. Information concerning the decrease or that concerning growth can be objectified between 3 and 6 months.
Risks of recurrence after operations and full stopping hormones? Are there statistics?
HL: Not to my knowledge, in this combination (stopping hormone taking - it all depends on which) and surgery (it all depends if the meningioma has been completely removed).
Do you notice an evolution in the number of cases of meningiomas throughout your years of practice?
HL: There is a single specialized register in France concerning brain tumors (in the United States, there is the largest world register, but the androcur is not marketed). The increase in the Gironde register is around 4% per year. The main factors of this increase are the aging of the population and access to medical imaging.
How many cases do you think you have in your service?
HL: Thirty.
Do you have grade 2 or 3 meningiomas in those due to Androcur?
HL: Yes, 1 single.
How many cases of meningiomas may have due to drugs as a percentage of cases listed in your hospital?
HL: probably less than 20% of cases.
What do you think of the analysis of the tumor to progesterone receptors?
HL: It is not enough.
Foreign research
Another question: are research on this subject only in France or other countries already worked on these subjects?
HL: The "hormone-dependent" character of meningiomas, although the term was questionable, appeared with the first works on meningiomas around 1930.
Relations between hormonal and meningiomas are studied in many countries with fairly contradictory results, sometimes. This is due to the difficulty of accurately drawing up the treatments in terms of duration and molecules (while knowing that they are not the same between Europe and the United States).
Treatments
Is there a reliable and serious study concerning the undesirable effects as a whole by type of treatment and also taking into account a specific overview of the development of nodules (including thyroid) with this type of treatment? Several people ask themselves the question. Could they/ they mention the study's references?
HL: Not to my knowledge. Women have a known propensity to develop thyroid pathologies.
We warmly thank Professor Hugues Loiseau for taking the TMSP for answering our questions.
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