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A meningioma is the most prevalent type of brain tumor that grows from the meninges, membranes around the brain and the spinal cord. This disease can be categorized as a brain tumor as it may press on the nearby area of the brain, nerves or vessels.
Meningiomas can affect their surrounding brain tissue, nerves or vessels, and lead to serious disability. However, in most cases it takes years for meningiomas to grow without any significant symptoms and signs. This means immediate treatment might not be required and the disease can be monitored over time.
Symptoms
In most cases, in the initial stage, a meningioma can have very subtle signs and symptoms before gradually worsening over time. This also depends on where in the brain or (rarely) spine, the disease is located. The signs and symptoms may include:
- Vision changes, including double or blurred vision
- Headaches
- Hearing loss or tinnitus
- Loss of memory
- Loss of smell
- Seizures
- Arm or leg weakness
- Language problems
Although in most cases a meningioma’s signs and symptoms progress in a slow manner, it might require immediate treatment. If the signs and symptoms such as headaches remain persistent and get worse over time, make an appointment with the doctor.
Contact emergency services if:
- Seizures that suddenly occur
- Sudden vision or memory changes
As the signs or symptoms of meningiomas are not distinct, they are often found from imaging scans done for reasons unrelated to the tumor, such as a head injury or headaches.
Causes
The cause of meningioma is unclear. However, cellular alterations in the meninges cause them to uncontrollably multiply, which leads to a meningioma tumor. Contributing factors that are believed to cause the disease include one’s genes, hormones (higher risk for women), or prior exposure to radiation (which is rare) and are still unknown.
Risk factors
Risk factors for a meningioma include:
- Radiation treatment. Radiation therapy to the head can increase the risk of a meningioma.
- Female hormones. Women are at a higher risk of developing meningiomas due to certain female hormones. Studies show the role of hormones, as well as birth control and hormone replacement therapy, may accelerate meningioma growth.
- Inherited nervous system disorder. The neurofibromatosis 2 disorder increases the risk of meningioma and other brain tumors.
- Obesity. Obesity, which is measured by the high body mass index (BMI), primarily increases the risk of many types of cancers including meningiomas, as observed in several studies. However, no clear relationship between obesity and meningiomas is found yet.
Diagnosis
Diagnosing a meningioma can be difficult as normally the disease progresses slowly without distinct symptoms. You may be referred to a neurologist in case the doctor suspects meningioma. A neurologist will conduct a thorough neurological examination for meningioma diagnosis, then do an imaging test with contrast dye, including:
- Computerized Tomography (CT) scan. CT scans, with X-rays creating cross-sectional images of a full picture of your brain, use an iodine-based dye in certain cases to make the picture more readable.
- Magnetic Resonance Imaging (MRI). This kind of imaging study uses a magnetic field and radio waves to create cross-sectional images of the structures of your brain. With this technology, the images of the brain and meningiomas are more-detailed.
- Biopsy. A doctor might also examine a sample of the tumor (biopsy) to check for other types of tumors and diagnose meningioma properly.
Treatment
Depending on contributing factors, the treatment for a meningioma includes
- Size and location of meningioma
- Growth rate of meningioma and its aggressiveness
- The patient’s age and overall health conditions
- Purpose of treatment
Observation
Meningiomas do not always require immediate treatment, especially those that are small and not aggressive without signs or symptoms. In such case, periodical brain scans and monitoring of symptoms might be required for meningioma evaluation.
Many options are available for those with growing meningiomas such as the following:
Surgery
Surgery is normally recommended for patients with the meningioma that causes growing signs and symptoms. Removing the entire tumor through surgery might not be possible, especially when a meningioma occurs near delicate structures in the brain or spinal cord. Surgeons, however, strive to remove the meningioma as much as possible.
The type of treatment selected for you after surgery depends on many factors.
- No visible tumor left: Regular follow-up scans are needed but may not need to take further treatments.
- Benign tumor with only a small piece remaining: Only periodic follow-up scans are recommended, but a stereotactic radiosurgery might also be required for small leftover tumors.
- Atypical or malignant tumor: Radiation therapy is usually required.
There may be common or specific risks arising from surgery, including infection and bleeding, depending where the meningioma occurs. Losing your eyesight may occur if a meningioma is removed around the optic nerve. It is recommended to consult with the surgeon about the specific risks from surgery.
Radiation therapy
Radiation therapy is recommended after surgery or in the case that cannot completely remove the meningioma. By using a large machine to aim energy beams at tumor cells, the goal of radiation therapy is to get rid of remaining meningioma cells as well as lowering the risk of recurring meningioma.
Advances in radiation therapy increase the dose of radiation to the meningioma while reducing the effect that radiation has on the patient’s health.
Radiation therapy options for meningiomas include:
- Stereotactic Radiosurgery (SRS): This kind of radiation treatment provides high-powered radiation beams targeting a precise point. Normally the process takes a few hours to complete. Radiosurgery is recommended for recurring meningiomas or ones that can’t be removed with conventional surgery.
- Fractionated Stereotactic Radiotherapy (SRT): It gradually provides small portions of radiation, which can be done once a day within a 30 days period. SRT is indicated for very large tumors which cannot be removed by radiosurgery or if the tumor is located in somewhere which cannot take powerful radiation (e.g., optic nerves)
- Intensity-Modulated Radiation Therapy (IMRT): In this approach, the intensity of radiation aimed at the meningioma site is modified using computer software. It is often indicated for meningiomas which are located on delicate parts of the brain or if the shape is complex.
- Proton beam radiation: Radioactive protons are used to target specifically only the tumor to minimize any harm to the structures around it.
Chemotherapy
Doctors may use chemotherapy medications, for meningiomas where surgery and radiation are not effective.
