What is a meningioma?

A meningioma is a usually slow-growing type of tumor that arises from the protective membranes, called meninges, which surround the brain and spinal cord. The majority (90%) of these tumor volumes are considered clinically benign, meaning that they are non-malignant tumors or non-cancerous.

Who gets meningiomas?

These tumor types are most likely to be found in a female from 40 to 60 years of age. These tumors are twice as common in women as in men but appear to favor no specific race or ethnic group. Statistically, there will be two per 100,000 people diagnosed annually with meningioma, and these tumors will account for 20% of primary intracranial tumors, and 12% of all tumors found in the spinal cord.

Factors known to increase an individual’s risk for developing a meningioma include exposure to radiation (including previous radiation therapy) and neurofibromatosis type two; a genetic condition that increases the risk of multiple brain and spinal cord tumors. There is some scientific evidence that suggests that female hormones could accelerate the development of a meningioma during pregnancy, previous head trauma could lead to a development of a meningioma (at the site of injury), and that some viruses could encourage the growth and development of a meningioma.

What are the symptoms of a meningioma?

Symptoms associated with meningioma are caused by increased pressure within the skull due to the growth of the meningioma. These symptoms may or may not include headaches, seizures, changes in vision (double vision/blurriness), nausea and vomiting, behavior/cognitive changes, memory loss, and/or loss of sensation/weakness in arms or legs.

What are the methods for detecting a meningioma?

A meningioma can be found in many ways. Once the symptoms have been reported to a physician, and there is cause to move forward with diagnostic investigation, a patient may undergo a neurological exam, and MRI with gadolinium contrast (preferable exam), or a CT with contrast.

What are the treatment options for meningiomas?

Depending upon what your specific case, there are several options for treating a meningioma. Some cases are best suited for simple observation. This “active surveillance” program will be directed by your physician and require periodic check-ups to monitor tumor volume and growth rate using MRI’s. For individuals requiring a more aggressive form of treatment, a physician may opt for any one, or combination of the following treatment paths: surgery, radiosurgery, radiotherapy, and/or much less commonly chemotherapy.

Surgery is the most common form of treatment for meningioma. This procedure could be total or partial resection of the tumor volume depending on the size and/or location of the tumor as well as the over all well-being of the patient. A surgeon may opt for less than total resection should the tumor be in close proximity to, or surrounding a critical structure, or if the patient is not healthy enough to endure the procedure successfully.

• Radiosurgery is a technique that utilizes high doses of radiation given in very few fractions if not one single procedure. Though radiosurgery can be successfully conducted with a few different types of equipment, and various types of radiation.
• GammaKnife is one specific machine used for such a purpose. The patient’s head is attached to a helmet that is inserted into the machine where 201 separate radioactive Cobalt-60 sources are collimated to intersect at the tumor site. Dose is given in a single treatment, which is also called single-dose stereotactic radiosurgery.

Radiation therapy uses radiation treatments to treat the tumor volume, and like radiosurgery can involve many different types of radiation. The two most common in today’s practice are photon and proton radiation therapy.

• Photon radiation utilizes a machine called a linear accelerator to deliver X-rays to treat tumors and spare normal tissue in several daily treatments.
• Proton therapy utilizes proton radiation to treat tumors much like photon radiotherapy; however, protons may be considered more suitable under circumstances involving inoperable tumors, post-operative residual tumor, or a patient with disease that is considered clinically inoperable to due to any number of constraints including anatomic proximity to critical structures such as the brain stem.

As each individual is very different, as is each tumor and the direction in pursuing a desired result will vary from patient to patient. Your health care team will assist in answering questions regarding each treatment method so as to select the path best suited to your needs as an individual patient.

What is the prognosis for a meningioma?

Disease prognosis can somewhat be determined by the “grade” assigned to the tumor. There are classifications for each tumor grade base on a number of tumor characteristics including microscopic structure and the growth pattern of each tumor. The following are tumor classifications for meningiomas:

WHO Grade 1 - slowest growing (benign non cancerous)-90%:

Meningiothelial meningioma*
Fibrous (fibroblastic) meningioma*
Transitional (mixed) meningioma*
Psammomatous meningioma
Angiomatous meningioma
Microcystic meningioma
Secretory meningioma
Lymphoplasmacyte-rich meningioma
Metaplastic meningioma

*most common subtypes

WHO Grade 2 - slightly more aggressive in growth (atypical)-7%:

Chordoid meningioma
Clear Cell meningioma
Atypical meningioma

WHO Grade 3 – most aggressive (anaplastic/malignant)-2%:

Papillary meningioma
Rhabdoid meningioma
Anaplastic meningioma