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How to treat Meningioma of the spine in case of recurrence?

Q: Name : Ahmed Sayeed KhanAge : 42 yrsGender : MaleMeningioma size : 3cmsMengingioma location : Mass arising from undersurfaceof dura C2-C3 (benign meningioma).Nationality : Indian----I am working in Riyadh, Saudi Arabia since last 18yrs. I was operated in India (Hyderabad) on 14 Jun2001 against spinal tumour C2-C3 level with cordcompression (meningioma).After the operation my surgeon told to come forre-examination after 6-months. But since operationmore 17 months elapsed, I could not visit my surgeon,as I am working in Riyadh and I was operated in India(cervical laminectomy C2-C3, excision of mass doneunder GA).Before operation there was a lot of compression andnumbness in my right hand (especially fingers), therewas lack of coordination and I was feeling likeloosing the strength day-by-day.After operation the whole of numbness has gone, but Ifeel exhausted after days work, my memory is not thatgood (forgetfulness) and I am not able to concentratewell on the work (basically I am a computer operator,clerical job).I am planning to viti India/Hyderabad in Dec-2002 tohave the check-up again (Apollo Hospital). Presently I am working in office since last 16 months without being absent for even a day (6-days a week, 9 hrs duty). But my main worry is re-occurence. I am not sure if the doctors have fully removed the tumour (thru excision) I feel exhausted after the days work and lack concentration. Pls advise what should I do, how much are the chance of recurrence of Meningioma?I dont have insurance/or medical facility for MRI inRiyadh (its very costly here), that is why I amplanning to visit India in Dec 2002. I have all thereports with me (Histopathology Report, DischargeSummary Report, pre-operation MRI report)Now, my question is (1) how to make sure and how to deduct that it is not re-surfacing? I suppose MRI is the only best diagnotic tool. (2) How safe and good is radioactive to supress if it is arises and where in India have the best facilities for gamma knife like treatment? Awaiting your detailed response.Ahmed Sayeed Khan,E-mail : askhan62@yahoo.com

A:Meningioma of the spine is not an uncommon tumour and as you also rightly know, the only way to know about recurrence is by repeated MRI. The symptome that you have mentioned (the once you are facing now ) are very non specific and do not have any correlation with spinal tumour. It is a good thing that you have planned to do the MRI, You may be having a post operative scan which must have shown the extent of excision. The extent of surgical excision is the best indicator of prognosis and further behaviour of a tumour of this kind. The best treatment in case of recurrence is decided based on the size of the tumour. In most cases resurgery is beter than radiotherapy. however, the choice of treatment is very much individualized for each patient. I do hope that you have a good stay in India and if all is well, you may not have any recurrence at all. so, I suggest you take it easy till the scan is done and then you can think further.

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