Rehabilitation from meningioma.

This chapter discusses the complex process of acute rehabilitation of patients after meningioma. Acute inpatient rehabilitation after meningioma utilizes an interdisciplinary approach to provide comprehensive rehabilitation through a team of physical, occupational, and speech therapists, nurses, doctors, recreational therapists, neuropsychologists, case managers and social workers, all of whom specialize in providing rehabilitation care. The prognosis of rehabilitation outcomes in this population is similar to that of the stroke population, and patients benefit from rehabilitation to maximize function in the setting of ongoing treatment. Common functional deficits include speech, cognitive, motor, and visual deficits. Medical complications include heterotopic ossification, venous thromboembolism, bowel and bladder complications, and pain. Patients must also be managed for behavioral complications such as agitation and maintenance of the sleep-wake cycle. The wide variety of functional outcomes following meningioma diagnosis and treatment necessitates a flexible rehabilitation course including testing for deficits, monitoring of outcomes, and ongoing therapy support.

Participation restrictions in patients after surgery for cerebral meningioma.

OBJECTIVES: To examine participation restrictions in patients after surgery for cerebral meningioma and to explore possible determinants of participation. DESIGN: Cross-sectional study. PATIENTS: Patients who had surgery for cerebral meningioma at the University Medical Center Utrecht, The Netherlands, between 2007 and 2009. METHODS: Clinical data were retrieved from medical files, and patients completed a postal questionnaire. Participation restrictions were measured with the Utrecht Scale for Evaluation of Rehabilitation-Participation. RESULTS: Of the 194 eligible patients, 76% (n = 136) participated in this study. Mean time after surgery was 32.6 months (standard deviation 10.6 months). Overall, patients showed favourable levels of participation. Nevertheless, many patients reported one or more problems of participation. Restrictions were most frequently reported regarding household duties, work or education. Twenty-three patients (32.9% of those who were in work before the meningioma) were not able to resume their job after surgery. Dissatisfaction was reported particularly regarding sports or other physical exercise. The presence of cognitive or emotional problems, multiple comorbidities and epilepsy were related to more participation problems. CONCLUSION: Patients who have had surgery for cerebral meningioma experience participation restrictions. The results of this study can be used to identify patients at risk of developing participation problems and to tailor rehabilitation goals.

Feasibility of the evidence-based cognitive telerehabilitation program Remind for patients with primary brain tumors.

Many patients with primary brain tumors experience cognitive deficits. Cognitive rehabilitation programs focus on alleviating these deficits, but availability of such programs is limited. Our large randomized controlled trial (RCT) demonstrated positive effects of the cognitive rehabilitation program developed by our group. We converted the program into the iPad-based cognitive rehabilitation program ReMind, to increase its accessibility. The app incorporates psychoeducation, strategy training and retraining. This pilot study in patients with primary brain tumors evaluates the feasibility of the use of the ReMind-app in a clinical (research) setting in terms of accrual, attrition, adherence and patient satisfaction. The intervention commenced 3 months after resective surgery and patients were advised to spend 3 h per week on the program for 10 weeks. Of 28 eligible patients, 15 patients with presumed low-grade glioma or meningioma provided informed consent. Most important reason for decline was that patients (7) experienced no cognitive complaints. Participants completed on average 71% of the strategy training and 76% of the retraining. Some patients evaluated the retraining as too easy. Overall, 85% of the patients evaluated the intervention as "good" or "excellent". All patients indicated that they would recommend the program to other patients with brain tumors. The ReMind-app is the first evidence-based cognitive telerehabilitation program for adult patients with brain tumors and this pilot study suggests that postoperative cognitive rehabilitation via this app is feasible. Based on patients' feedback, we have expanded the retraining with more difficult exercises. We will evaluate the efficacy of ReMind in an RCT.

Porous polyethylene implant reconstruction of the orbit after resection of spheno-orbital meningiomas: a novel technique.

BACKGROUND: Spheno-orbital meningiomas (SOM) are complex tumors involving the middle cranial fossa and orbit. Following resection of these tumors, reconstruction of the orbit can be challenging. Inadequate reconstruction may lead to cosmetic deformities and functional complications. OBJECTIVE: The development of a technique for orbital reconstruction which is technically straightforward, cost-effective, with an excellent functional and cosmetic outcome. TECHNIQUE: Twelve patients with SOM each underwent a modified orbital-zygomatic craniotomy with osteotomies based on individual tumor location. After tumor resection, the lateral orbit and orbital roof, where necessary, were reconstructed using a 1 mm porous polyethylene sheet, customized to reconstruct the bony anatomy of the lateral and superior orbit and secured with 1.5×4 mm titanium screws into the orbital roof and rim. RESULTS: All patients demonstrated stabilization or improvement of vision and satisfactory cosmetic outcomes. One complication (surgical site infection) was noted. Follow-up imaging was obtained at regular intervals. The resection cavity was easily visualized without interference from the implant in each case. One patient developed tumor recurrence requiring re-operation 20 months after the initial procedure. CONCLUSIONS: Use of a 1mm porous polyethylene sheet for reconstruction of the lateral orbit offers an excellent functional and cosmetic outcome, does not interfere with postoperative imaging, is technically straightforward, and is cost-effective.

Living in a paradox--women's experiences of body and life-world after meningioma surgery.

AIMS: The aims of the study were to describe how persons who have undergone benign meningioma surgery experience their body and life-world and to illuminate the meaning of the illness, operation and recovery. BACKGROUND: Meningioma, which is often benign, is the most commonly diagnosed brain tumour. Studies have shown that persons with meningioma tend to be more psychologically affected than persons with other brain tumours. To our knowledge, no previous studies have focused on the life-world or body experience of these persons. METHOD: Narrative interviews with seven women conducted over a 6-month period (2008-2009) were analyzed using a phenomenological hermeneutical method. Findings. Four themes were identified: In between double threats: the tumour and operation: the participants seemed to perceive a paradox in the sense that the tumour was both benign and threatening and the surgery both curing and risky; the wound as an open gate: the wound is visibly healed, but perceived as unhealed; the suffering body overflows life: the participants were prevented from regaining their body, feeling fragile and oversensitive to impressions; and the need to be embraced by attention: taking the participants' needs seriously facilitated understanding of the diagnosis. CONCLUSION: The participants in this study described emotional distress when recovering from meningioma surgery. It is essential for nurses to be aware of the various meanings people ascribe to events that disrupt their lives and the transition process in connection with meningioma treatment.

Functional recovery of patients with brain tumor or acute stroke after rehabilitation: a comparative study.

The aim of this study was to compare the locomotor functional recovery of patients with brain tumor and patients with stroke. Each patient with a brain tumor was matched to a patient with stroke according to the lesion side. Twenty-one patients operated for intracranial tumors and 21 patients with stroke were studied. The mean ages (+/- standard deviation) of patients were 52.5+/-16 years for patients with brain tumor and 56.7+/-11 years for patients with stroke. For each patient, the age, gender, presence of aphasia, smoking habit, co-morbidities, lesion origin and lesion size (for the brain tumor group) were recorded. Locomotor and functional recovery were evaluated by using the Postural Assessment Scale for Stroke, the Berg Balance Scale, Motor Assessment Scale and the mobility section of the Functional Impairment Measure. There was no difference regarding demographic characteristics between the two groups. After rehabilitation both groups had significantly improved in terms of all parameters, but the extent of improvement did not differ between the two groups.

Neurological manifestations following partial excision in spinal meningioma: case report.

Presented here is a 16-year-old girl who was referred on 30th January 1996 with diagnosis of cord compression with spastic paraplegia with sensory level at T7/T8. CT scan myelogam confirmed soft tissue density mass displacing cord to the left with no dye being seen beyond T3. Thoracic spine decompressive laminectomy was performed on 1st January 1996 at Nairobi West Hospital extending from T3 to T6 level, which revealed a fibrous haemorrhagic tumour. Histology showed meningioma (mixed fibrous type and meningoepitheliomatous type) with many psammoma bodies. She had a stormy post-operative period, with infection and wound dehiscence. This was treated with appropriate antibiotics and wound care. She was eventually rehabilitated and was able to walk with the aid of a walking frame because of persistent spasticity of right leg. She was seen once as an outpatient by author on 6th July 1996, she was able to use the walking frame, but the right leg was still held in flexion deformity at the knee. She was thus referred to an orthopaedic surgeon for possible tenotomy. She was able to resume her studies at the University ambulating using a wheel chair and walking frame. She presented with worsening of symptoms in 2001 (five years after her first surgery). MRI scan thoracic spine revealed a left anterolateral intradural lesion extending from T3 to T5 vertebral body level compressing and displacing the spinal cord. She had a repeat surgery on 6th March 2001 at Kenyatta National Hospital; spastic paraparesis and urinary incontinenece persisted. She also developed bed sores and recurrent urinary tract infections. She was followed up by the author and other medical personnel in Mwea Mission Hospital where she eventually succumbed in 2005, nine years after her first surgery. This case is presented as a case of incompletely excised spinal meningioma to highlight some of the problems of managing spinal meningiomas when operating microscope and embolisation of tumours are not readily available. Also the family experienced financial constraint in bringing the patient for regular follow-up, and getting access to appropriate antibiotics, catheters and urine bags.

Rehabilitation outcomes in patients with brain tumors and acute stroke: comparative study of inpatient rehabilitation.

OBJECTIVES: To investigate functional outcomes after hospital rehabilitation of patients surviving craniotomy for primary brain tumor excision compared with post-stroke patients. DESIGN: The database of the Neurological Rehabilitation Department "C" of Loewenstein Rehabilitation Center was used to investigate primary brain tumors and first ischemic and hemorrhagic stroke patients admitted for hospital rehabilitation during an 11-yr period, between January 1993 and August 2004. Particular attention was paid to age and sex distribution, onset-to-admission interval, length of stay, functional status at admission and discharge, functional gain (DeltaFI change) as measured by the FIM instrument. RESULTS: A total of 168 patients with craniotomy for primary brain tumor excision (128 intracranial meningiomas and 40 cerebral gliomas) and 1660 first-stroke patients were admitted to the department for rehabilitation during the study period. Mean patient age was 59.9 yrs in meningioma group, 54.1 yrs in the glioma group, and 60.4 yrs in the stroke group. In the meningioma and stroke groups, male patients were in the majority (62 and 70%); in the glioma group, there was equal sex distribution. On average, patients were admitted to rehabilitation treatment 13 days after meningioma excision, 34 days after glioma operation, and 21.6 days after stroke. Functional variables during inpatient rehabilitation were found to be similar in the all groups. Average FIM rating at admission was 80.07 in the meningioma group, 68.2 in the glioma group, and 70.4 in the stroke group. Average discharge FIM rating was 90.3 for patients with meningiomas, 80.7 for patients with gliomas, and 87.8 for stroke patients. Functional gain was 17.9 for meningioma patients, 17.2 for glioma patients, and 21.8 for stroke patients. Average length of stay was 24 days for the meningioma group, 23 days for the glioma group, and 75.4 days for stroke patients; 88.1% of stroke patients, 91.7% of meningioma patients, and 82.7% of glioma patients were discharged to their homes, and 5.4, 3.4, and 8.6%, respectively, were discharged to nursing homes. CONCLUSIONS: Patients with brain tumors can achieve good functional outcomes with a shorter length of stay.

The rehabilitation outcome of spinal meningioma induced proprioception deficit.

Chronic non-traumatic myelopathy developed in a woman who presented symptoms of gait ataxia, right leg motor weakness, dysesthesia and urinary difficulty. Clinical evaluation revealed right leg weakness and global anesthesia as well as temperature, vibratory and proprioception sensation loss below the T-9 level and deep tendon hyperreflexia over the lower extremities. Magnetic resonance imaging showed an extra-intramedullary meningioma at the T-9 level. Following microscopic subtotal excision of the tumor, the patient underwent satisfactory rehabilitation programs with outstanding outcomes presented using the neurological scoring system, functional balance grade, postural analysis of Baropodometry screen and single leg standing time.

Fisioterapia basada en la ontogénesis del movimiento, a propósito de un caso de meningioma intraventricular / Physiotherapy based on the ontogenesis of the movement, by the way of a case of meningioma intraventricular

Las patologías de origen neurológico encierran un gran número de incógnitas respecto a su origen, la evolución y el tratamiento a aplicar con el fin de volver a la normalidad previa a la enfermedad. Los meningiomas, por su propia naturaleza conllevan una evolución impredecible, suponen un verdadero misterio tras la intervención aunque la resección sea total y sin que exista recidiva, como el caso que nos ocupa. El abordaje del tratamiento fisioterápico desde el punto de vista del ámbito motor, basándonos en la ontogénesis del movimiento, tal y como el desarrollo humano evoluciona en su curso natural, pocas veces es posible plantearlo en los centros de rehabilitación por las condiciones de espacio, tiempo o ratio de pacientes/profesional. El presente trabajo, pese a basarse en un único caso y teniendo en cuenta que cada caso es único, pretende aportar un punto de vista no tan usual en el tratamiento fisioterápico en este tipo de pacientes. Señalar además que no es un tratamiento acabado, sino una revisión de 24 meses de trabajo, pues el proceso continua (AU)

The realities of postoperative disability and the carer's burden.

Outcome after high-risk, complex neurosurgery for progressive skull base pathology, and its effect on carers, has been examined. Two different outcome measures were used. The Glasgow Outcome Score (GOS) assesses overall social capability and dependence of the patient, while the 36 item short-form health survey (SF-36), a generic quality of life measure, can be compared directly with the general population. Overall outcome using the GOS indicated a favourable outcome for 13 of the 17 patients studied. The SF-36 demonstrated that more than half the patients were functioning at a level below the accepted norm. The reasons for this discrepancy and the validity of outcome scales have been analysed. In addition, the effect upon carers, its relevance to assessment of outcome, and the need to involve potential carers in the process of informed consent was stated. Our conclusions are applicable throughout the surgical specialities, and especially to high-risk complex surgery.

Incidence of neurologic deficits and rehabilitation of patients with brain tumors.

OBJECTIVE: To report and discuss common neurologic problems in adults with brain tumors admitted for inpatient rehabilitation at an acute rehabilitation center. DESIGN: Retrospective, descriptive, case series of 51 consecutive adult patients (65% male), with a variety of tumor types (31.3% glioblastoma, 25.5% meningioma, and 25.5% metastatic). Outcome measures were the functional status as measured by the FIM scores, the length of rehabilitation stay, and discharge dispositions. RESULTS: The most common deficit was impaired cognition (80%), followed by weakness (78%), visual-perceptual deficit (53%), sensory loss (38%), and bowel and bladder dysfunction (37%). Less common problems, in decreasing incidence, were cranial nerve palsy, dysarthria, dysphagia, aphasia, ataxia, and diplopia. Thirty-eight (74.5%) patients had three or more concurrent neurologic deficits, and 20 (39.2%) patients had five or more deficits. Concurrent deficits among patients with hemi- and tetraparesis involved cognition (n = 29 patients), visual-perceptual function, sensation, cranial nerve palsy, and neurogenic bowel/bladder. The average admission FIM score of 67.2 increased to 87.1 at the time of discharge, with similar gains between patients with primary brain tumor and metastatic disease. Thirty-five patients were discharged home, seven to a nursing home, and one to hospice care; there were eight acute transfers. CONCLUSIONS: Impaired cognition, weakness, and visual-perceptual deficits were the most common problems in this study population. Our study supports the benefits of comprehensive and interdisciplinary rehabilitation for patients with primary as well as metastatic brain tumors.

Quality of life following surgery for intracranial meningiomas at Brigham and Women's Hospital: a study of 164 patients using a modification of the functional assessment of cancer therapy-brain questionnaire.

The objective of this study was to determine the subjectively reported quality of life (QOL) of patients with meningiomas surgically treated. Demographic, medical and outcomes data on 164 patients were retrospectively analyzed with the use of the Brain Tumor Center database at the Brigham and Women's Hospital, Boston, MA. The patients were contacted via a telephone survey and were asked 26 standardized QOL questions based on a modification of the validated Functional Assessment of Cancer Therapy-Brain (FACT-BR) Study, which used only questions adjuvant to brain tumor patients. The patients' ages ranged from 23 to 87 years. The mean follow-up time after intracranial surgery was 33 months and median follow-up time was 28 months, with a range of 0 to 165 months. Of those 164 patients still living, 95% (155) participated in the telephone survey. 80% reported being satisfied with their post-treatment quality of life; 86% reported that they could write, read, drive and return to work at their pre-morbid level of functioning; 87% described themselves as 'independent' and able to act on their own initiatives. Our study found a high level of satisfaction for QOL in patients who have undergone surgery for intracranial meningiomas. Patients, by their own report, are able to lead independent, personally satisfying, meaningful and productive lives. This provides useful information to share with patients in discussions regarding surgical treatment of these lesions.

Postoperative ambulation of patients with intraspinal neurilemomas and meningiomas.

Factors affecting the postoperative ambulatory state of patients with intraspinal neurilemomas and meningiomas were evaluated in 92 patients who underwent surgery at the Chang Gung Memoriam Hospital. The patients' records were reviewed retrospectively and leg power grading was noted (Medical Research Council of Great Britain grading system, zero to five). Of the 89 patients with a preoperative leg power of 1 or better, 87 could walk with or without aids shortly after surgery. The remaining three patients, with a preoperative leg power of zero, were all wheelchair-bound postoperatively. The presence of sensory deficits and sphincter incontinence did not correlates with a poor postoperative ambulatory state, provided the preoperative leg power was above zero. The average period between the onset of the earliest symptoms and the establishment of the diagnosis was 68 weeks for patients with intraspinal neurilemomas and 71 weeks for those with meningiomas. Surgical for patients with neurilemomas were as good as those with meningiomas. Patients with multiple spinal neurilemomas did not fare any worse after surgery.

Prognostic factors of intraspinal neurilemmoma and meningioma with severe preoperative motor deficits.

A total of 20 cases of intraspinal benign tumors (13 neurilemmomas and seven meningiomas) with severe motor deficits operated on from 1978 to 1991 were reviewed. Motor deficits were graded according to the classification of Cooper and Ebstein. Grade IV represented slight movement of the lower extremities, but no ability to walk or stand; grade V was complete paralysis. There were 16 patients classified as grade IV and four classified as grade V. All patients underwent total excision of the tumor and postoperative physical therapy. After various periods of follow-up, 13 patients could walk independently, five could walk with assistance, one could stand, and one was still restricted to a wheelchair. For the 13 patients who could walk independently, 11 were able to stand within one month after surgery. In contrast, of the seven patients who could not walk independently, only two managed to stand within one month of surgery. Statistically, age, duration of paraplegia and tumor location all had a significant influence on the recovery of motor function. Being able to stand within one month of surgery was predictive of a good recovery.

El Comportamiento Biológico del Meningioma y sus Perspectivas Terapéuticas

El estudio biológico de los meningiomas ha desarrollado múltiples espectativas terapéuticas que se encuentran en permanente renovación y perfeccionamiento. Se presenta una revisión actualizada de estos aspectos y se discuten las dos posibilidades más importantes que tienen los pacientes con este tipo de tumor en quienes el tratamiento quirúrgico no es el más favorable: manipulación hormonal y radiocirugía estereotáxica

El comportamiento biológico del meningioma y sus perspectivas terapeúticas

El meningioma ha sido, hasta el momento, la neoplasia cuyo estudio ha arrojado mejores perspectivas en el desarrollo de sistemas de tratamiento basados en las características biológicas de los tumores. Actualmente son escasas las aplicaciones clínico-terapéuticas, motivo por el cual, se deben implementar nuevas estrategias de investigación cuyos resultados se encaminen en beneficio de los pacientes que padecen de esta patologia. Este artículo presenta una revisión actualizada de los aspectos más importantes del meningioma, haciendo énfasis en su comportamiento biológico

[Long-term results of the surgical treatment of parasagittal meningiomas]. / Otdalennye rezul'taty khirurgicheskogo lecheniia parasagittal'nykh meningiom.

The article analyses the late results of surgical treatment of 123 patients with parasagittal meningiomas of various localization along the superior sagittal sinus (SSS) and falx cerebri (FC). Invalidism of patients after operations for meningiomas of the middle third of the sagittal line is still high because of stable motor defects. The results of operations for SSS resection without restoration of venous outflow of the hemisphere are poorer. Recurrences of the disease were revealed in one fourth of patients in different periods after surgery. The possibility of rehabilitation of the patient after an operation for recurrences of the tumor considerably reduces with each subsequent recurrence.