Convexity Meningioma

"Did I just have a seizure?" That is what Jarrod San Angel, 43, asked his girlfriend, Clara, after coming to. The New York City couple had been watching television when Mr. San Angel began convulsing and blacked out. Clara took him to the emergency room at Mount Sinai Queens, where CT and MRI imaging identified a brain tumor the size of a cherry along the surface of the top right side of his skull, known as a convexity meningioma. Learn more about Jarrod's treatment and recovery.

Convexity meningiomas are tumors that grow on the surface of the brain (called the convexity). These tumors are about 20 percent of all meningioma cases. Convexity meningiomas are some of the most surgically accessible meningiomas, so we can usually remove them (resection) completely. As a result, these tumors have a low recurrence rate.

The esteemed and experienced neurosurgeons at Mount Sinai Health System specialize in treating complex cases, such as convexity meningiomas. We offer multidisciplinary and individualized care.

Most convexity meningiomas are noncancerous. There are three grades of these tumors: Grade I (slow growth with distinct borders), Grade II (atypical), and Grade III (malignant or cancerous).

Usually you do not experience any symptoms until they grow or press on surrounding structures. You may experience these symptoms:

• Headaches result from a meningioma altering the pressure levels in the brain. They range from mild to severe and can occur off and on or continually. Sometimes you may also experience nausea or vomiting or difficulty concentrating.
• Seizures can arise fromcompression, swelling, and invasion of the brain tissue. These conditions can even cause epilepsy. You may experience involuntary muscle spasms, visual hallucinations, confusion, or fatigue.
• Neurological deficits aremorecommonwhen aconvexity meningioma develops near the motor and sensory areas of the brain. These tumors can affect your coordination, sensation to touch, or strength in your arms and legs. Typically, tumors pressing on one hemisphere of the brain cause symptoms on the opposite side of the body. For example, a meningioma exerting force on the right hemisphere can cause weakness or tingling in your left arm or leg. In addition, you might have difficulty speaking (finding words and understanding language) if the tumor presses on the left hemisphere of the brain, which controls speech. Other neurological problems include memory and concentration difficulties, personality changes, and vision loss or double vision.
• Vertigo is associated with small supra-tentorial convexity meningiomas.
• Syncope or fainting can happen whenaconvexity meningioma changes the cerebral blood flow.

We usually discover meningiomas inadvertently and before you experience any symptoms, as we may be looking for something else. Typically, we perform a magnetic resonance imaging (MRI) or a computed tomography scan after an accident or because you have some unrelated symptoms such as headache, hearing loss, dizziness, or vertigo. Then the tumor appears on the scan.

Treatments Available

Convexity meningiomas sit on the brain’s surface (as opposed to deep within the brain), which makes them easier to treat than other types of meningiomas. Our multidisciplinary team assesses each tumor’s size, location, and other qualities to determine the most appropriate course of action. We often use one of four approaches.

• Surveillance, or “watchful waiting,” involves regular MRI scans to monitor growth.
• Surgery is appropriate if the tumor is symptomatic or growing and you are at an age in which surgery is appropriate. We offer several procedures to remove the meningioma, including craniotomy, minicraniotomy, and minimally invasive and image-guided treatments. If the meningioma is large and has a rich vascular supply, we may perform a pre-surgery embolization.
• Stereotactic radiosurgery is best for you ifsurgery is not advisable or if we cannot remove all of the meningioma.
• Chemotherapy works in rare cases, such as if the tumor is aggressive or recurrent.

If you have been treated for convexity meningioma, you will likely leave the hospital two to four days after surgery. Once you get home, you should be able to take care of yourself without a home attendant, visiting nurse, or specialized home care. We do encourage you not to drive or do your own errands for the first two weeks after you leave the hospital.

You will meet with your neurosurgeon within 7 to 14 days after discharge to discuss your progress and plans for increasing activity. We typically limit heavy exercise during the first two weeks, but we encourage you to walk up to 20 minutes a day, three times a day to avoid complications of inactivity and bed rest.

Different people respond differently to anesthesia and surgery. Most people return to work within two to six weeks after the procedure or even sooner, depending on your recovery process as well as the nature of your job, the length of your commute, and any underlying medical conditions. Rehabilitation is sometimes helpful if you are experiencing any neurological difficulties.