Where to Have Meningioma Surgery in the Philippines

Meningioma surgery in the Philippines is done at government and private hospitals, in Metro Manila and other cities. Choose one with a neurosurgeon, MRI, an operating microscope, an intensive care unit (ICU) and a pathologist, who examines the tumor. After a seizure or sudden weakness, go to the emergency room now. If symptoms slowly worsen, see a neurosurgeon soon.

What does a hospital need to do meningioma surgery?

A hospital that does meningioma surgery needs a neurosurgeon, the doctor who operates on the brain. It needs an MRI scanner for the scans before and after, an operating microscope, an ICU bed after surgery, and a pathologist. It also needs a radiotherapy or radiosurgery center (a place that gives radiation treatment) it can send you to if some tumor is left.

MRI is the main scan. It uses a strong magnet to show the brain in detail. A UK guideline from NICE advises MRI, with and without contrast dye (a dye given through a vein), as the first test for a suspected meningioma, unless MRI cannot be done. A CT scan can be added to check the skull bone if the tumor may involve it.

The operation does two jobs. It relieves the symptoms caused by the tumor pressing on the brain. It also gives tissue, which a pathologist examines under a microscope to name the tumor’s type and grade, a rating of the tumor. The European guideline (EANO) says this tissue is needed for a definitive diagnosis.

The aim of the operation is to remove as much tumor as is safe while protecting brain function. How much can be removed depends on where the tumor sits, its size, how firm it is, and how close it is to important nerves and blood vessels. When full removal is not safe, the surgeon removes part of it on purpose.

The tumor that remains can be watched with scans or treated with radiation, either radiotherapy or radiosurgery. Radiosurgery is a focused dose of radiation given without a cut. This treatment may be given at another hospital, so ask where it would be done before you choose.

Do you need surgery at all before choosing a hospital?

Not every meningioma needs an operation right away. The EANO guideline names observation, meaning repeat scans, as the first option for a meningioma found by chance that causes no symptoms. Surgery is the first option for a tumor that is growing or causing symptoms.

For a tumor found by chance with no symptoms, the guideline advises an MRI once a year at first. This advice is graded as weak evidence. If your scan found a small tumor and you feel well, first ask whether a small meningioma needs surgery or can be watched, before you ask where.

For referring doctors: what to send

For a patient with a suspected or confirmed meningioma, send the contrast MRI images themselves, on a disc or by a secure link, not only the report. Add the symptoms and how fast they are changing, any seizures and antiseizure medicine, any anticoagulant (blood thinner), and other illnesses.

A patient with a sudden or worsening deficit, meaning a new loss of function such as weakness, belongs in the emergency room. A tumor found by chance with no symptoms can be referred to clinic. The EANO guideline names observation as the first option for it.

I accept referrals for adult meningioma at the Lung Center of the Philippines and the National Kidney and Transplant Institute.

Can you have meningioma surgery at a government hospital?

You can have meningioma surgery at a government hospital that has a neurosurgery service. Admission at a government hospital needs lead time. Plan for a wait between the first consult and the operation, and ask at that first visit how the hospital schedules admission and what papers to prepare. If your symptoms get worse while you wait, tell your neurosurgeon right away. If a sign starts suddenly, go to the emergency room now.

I operate on adults with meningioma at the Lung Center of the Philippines and the National Kidney and Transplant Institute (NKTI). Both are government hospitals in Quezon City. For a planned operation, these are where I admit patients.

Some patients need to be admitted sooner than a government hospital bed allows. For them, I admit at Capitol Medical Center in Quezon City. A patient who needs an ICU bed quickly is admitted at Manila Central University (MCU) Hospital in Caloocan.

Ask the same questions at a government hospital as at a private one. Who is the neurosurgeon? Is there an ICU bed after surgery? Where are the MRI scans done? Who reads the tissue? The full list of questions, in the section on private hospitals, applies to every hospital.

When your budget is limited

When your budget is limited, PhilHealth and the Malasakit Center can cover part of the hospital bill. Government hospitals also give charity care to families who need full help. Ask the hospital’s medical social service how to apply.

If your family cannot pay at all and you would like me as your surgeon, I also operate at East Avenue Medical Center, a government hospital in Quezon City. Ask for an estimate early and check it against the items on a meningioma surgery bill, so the money is ready before admission.

Private hospitals in Metro Manila for meningioma surgery

Private hospitals in Metro Manila also do meningioma surgery. Choose one by the neurosurgeon and the support around the operation. Ask every hospital you consider the same questions, so you can compare them on what matters for your tumor.

Questions to ask:

• Who is the neurosurgeon, and will that surgeon do the operation?
• Is an ICU bed ready for after the operation?
• Is the MRI done in the hospital, before and after surgery?
• Who examines the tumor tissue, and when is the result ready?
• If some tumor stays, where would radiotherapy or radiosurgery be done?
• Who sees you after you go home, and where are the follow-up scans done?
• What are the risks for a tumor in my location?

The last question matters at any hospital. The EANO guideline advises that the surgeon discuss the risks fully before surgery. These include risks tied to where the tumor sits, and general risks such as seizures and hydrocephalus, meaning fluid building up inside the brain.

If you have an HMO, ask it in writing how much of the operation, the ICU stay and the follow-up scans it covers. Ask before admission, not at discharge.

Can you have meningioma surgery in Cebu, Davao and other cities?

You can have meningioma surgery outside Metro Manila, in a city with a neurosurgeon and the support listed above. A 2023 national survey counted 174 neurosurgeons practicing in the Philippines. The survey’s summary used here does not list them by city, so check with the hospital near you directly.

That survey also asked what operations Filipino neurosurgeons do. Biopsy or removal of brain tumors was among the top procedures they reported. Tumor surgery is part of general neurosurgery practice in the country, not only in Manila.

If you live in Cebu, Davao or another city, ask the local neurosurgeon the questions in the list above. Ask also where the scans after surgery will be done, and where radiation would be given if it is needed.

What if there is only one neurosurgeon near you, or none?

If there is only one neurosurgeon near you, see that surgeon first and ask what your tumor’s location needs. If there is no neurosurgeon near you, an online consult or a second opinion can review your scans before you plan a long trip. A seizure or a sign that starts suddenly still needs the nearest emergency room now.

The 2023 survey found about one neurosurgeon for every 600,000 people in the Philippines. In nine provinces, neurosurgeons were available only part-time. In 35 provinces there was none, which leaves about 24 million people without one nearby.

A tumor near the surface of the brain and a tumor deep at the skull base can need different things. Ask the surgeon near you which one yours is. Ask whether the operation, the ICU care and the scans after it can all be done at that hospital.

You may ask for a second opinion at any point before surgery. A second neurosurgeon needs the same films and reports, so keep copies. An online consult can do this without the trip, and only the operation then needs the travel.

What to plan if you travel to Manila for surgery

If you travel to Manila for meningioma surgery, plan three things before you leave: your records, the people who come with you, and your follow-up. In one guideline’s schedule, follow-up lasts years. Agree before surgery on where those check-ups and scans will be done.

Bring every film, disc and report, in one folder. Bring a bantay, a family member who stays with you in the hospital. Arrange where the family will stay near the hospital. Your surgeon will tell you how long to expect in the hospital, and when it is safe to travel home.

A UK guideline from NICE advises regular check-ups after treatment for meningioma. These check-ups look at changes in the body, in mood and in thinking. The guideline does not say they must happen at the hospital that operated.

The same guideline gives one possible scan schedule. For a grade 1 meningioma that was fully removed, it suggests a scan at three months. Then a scan once a year up to year three, and once every two years up to year nine. After that, stopping the scans may be considered.

Grade 2 and grade 3 tumors, and tumors with some left behind, are scanned more often in that guideline. Your own surgeon sets your schedule. An online consult before you travel can sort the papers, and one after you go home can review later scans.

Who does skull base surgery in the Philippines?

In the Philippines, skull base meningiomas are operated on by neurosurgeons. The skull base is the floor of the skull under the brain, where important nerves and blood vessels pass. Ask the neurosurgeon you see whether your tumor is at the skull base, and what the plan for it is.

A tumor there sits close to those nerves and vessels. The EANO guideline says this closeness is one of the things that decides how much tumor can be removed safely. Some tumor may be left on purpose to protect brain function, which is why some skull base tumor stays after surgery.

Surgery abroad versus here: is it worth going overseas?

Whether surgery abroad is worth it depends on practical things, because the studies on this page did not compare results abroad with results here. Think about who sees you after the operation, where your scans are done, and what happens if a problem appears after you fly home.

Follow-up is the largest practical question. In the NICE schedule above, even a fully removed grade 1 tumor has scans for nine years. If you live in the Philippines, those scans and check-ups happen here, so a doctor here needs your full records.

Ask these questions before you book an operation abroad:

• Who will see me after I fly home, and how will they get my records?
• Where will the follow-up MRI scans be done, and who will read them?
• If a problem appears after I am home, which hospital here takes over?
• Will I come home with the operation notes, the tissue report and the scan images?

Frequently asked questions

Can I have an online consult before choosing a hospital?

Yes, an online consult can review your MRI images and reports and help you plan where to have meningioma surgery. A full examination still needs a visit in person. I offer online consults for patients too far from Quezon City, booked on the consultation page.

Does PhilHealth cover meningioma surgery?

PhilHealth can cover part of the hospital bill for meningioma surgery. Ask the hospital’s PhilHealth desk how much applies to your operation. Ask the medical social service about other help, such as the Malasakit Center, before admission.

Can follow-up scans be done near home after surgery?

Follow-up scans after meningioma surgery can be taken at a hospital near home if your surgeon agrees, with the images sent to the surgeon. Agree on this before surgery. In one UK guideline’s schedule, follow-up scans go on for years, even after full removal.

What if the patient with a meningioma is a child?

When the patient with a meningioma is a child, I treat them at the Philippine Children’s Medical Center (PCMC), Quezon City, with my team. My clinic there is in Room 22 on Wednesday from 2 PM. Families far from Quezon City can book an online consult.

Is the operation the same wherever it is done?

The aim of meningioma surgery is the same everywhere: remove as much tumor as is safe while protecting brain function. How much can be removed depends on the tumor’s location and what it touches. The EANO guideline notes that management varies between countries and centers, because few controlled trials exist. Your surgeon can explain the stages of meningioma surgery at that hospital, from the scans to the ICU and going home.

See sources

1. Goldbrunner R, Stavrinou P, Jenkinson MD, et al. EANO guideline on the diagnosis and management of meningiomas. Neuro-Oncology. 2021. PMID 34181733; doi:10.1093/neuonc/noab150
2. National Institute for Health and Care Excellence (NICE). Brain tumours (primary) and brain metastases in over 16s (NICE guideline NG99). 2018. https://www.nice.org.uk/guidance/ng99/chapter/Recommendations
3. Baticulon RE, Lucena LLN, Gimenez MLA, et al. The neurosurgical workforce of the Philippines. Neurosurgery. 2023. PMID 37931081; doi:10.1227/neu.0000000000002630