Meningiomas
Definition
A meningioma is a tumor of the protective linings of the brain and spinal cord. These linings are called meninges. Most meningiomas are benign, though some may be malignant. Benign meningiomas are generally slow growing. They usually don’t cause problems unless they are pushing on the brain stem and/or compressing neuro structures such as optic and cranial nerves. Malignant meningiomas (also called aggressive or anaplastic) are less common. These tumors are faster growing. They often cause problems, and can cause some swelling in the brain. Often both benign and malignant meningiomas require some form of treatment. These could include surgery and/or radiation therapy depending upon the location of the tumor and symptoms.
Causes
The exact cause of meningiomas is unknown. However, there are a few theories under study.
These include:
- Certain hormones may increase the growth of meningiomas
- Radiation exposure, especially to the face or head, can increase the risk of developing meningiomas
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for meningioma include:
- Sex: Female; meningiomas are twice as common in women than men
- Age: 40-70
- History of breast cancer or sarcoma, as part of the Li-Fraumeni Syndrome
- A diagnosis of neurofibromatosis type 2
- Having received radiation to the face or head as a child (for acne, warts, fungal infections, or for the treatment of other tumors)
Symptoms
Symptoms of meningioma are usually related to the area of the brain that is affected. Often the symptoms are caused by increased pressure within the skull.
Symptoms may include:
- Headaches
- Vomiting
- Visual problems
- Changes in behavior
- Epilepsy
- Pain
- Loss of sensation or weakness in the arms and legs
- Loss of bladder or bowel control
- Slurred speech (if tumor is on the left side of the brain)
- Loss of coordination and memory loss (if tumor is in the temporal lobe)
- Difficulty writing (if tumor is in the parietal lobe)
Diagnosis
Your doctor will ask about your symptoms and medical history and perform a physical exam. You will also be given a neurologic test to assess your motor skills. Other tests may include:
- CT Scan –a type of x-ray that uses a computer to make pictures of the inside of the body, in this case the head
- MRI Scan –a test that uses magnetic waves to make pictures of the inside of the body, in this case the head
- Angiogram –the injection of a special dye to highlight blood vessels in the brain
- Electroencephalogram (EEG) –a test that records the brain's activity by measuring electrical currents through the brain
Meningiomas can occur in the head or in the spinal cord. Meningiomas in the head can appear in different locations:
- Convexity
- Parafalcine
- Olfactory groove
- Torcula
- Tuberculum sellae
- Sellae meningiomas (in the sella occupying the pituitary gland space)
- Planum sphenoidale
- Petroclival
- Tentorial
- Supratentorial
- Infratentorial
- Posterior fossa
- Foramen magnum
- Infratemporal fossa
Treatment
Treatment will depend on the size and position of the tumor, as well as the patient’s general health. The main types of treatment for meningiomas are:
Surgery
Surgery may be recommended if the tumor is located in an area of the brain that is accessible to surgery. Most surgeries can be performed without causing neurologic damage.
The expanded endonasal approach (EEA) is a state-of-the-art surgical procedure that can be used to treat meningiomas of the skull base, depending on the location of the tumor.
Tumors located in the following areas can be treated with the endoscopic endonasal approach:
- Transribriform: olfactory groove meningiomas
- Transplanum: planum sphenoidale meningiomas and tuberculum sellae meningiomas
- Transsellar : sellar meningiomas
- Transclival: petroclival meningiomas and foramen magnum
- Transodontoid: foramen magnum meningiomas, anterior upper spine
- Transpterygoid: infratemporal fossa meningiomas
- Transorbital: intraconal meningiomas (located inside the orbit) or extraconal meningiomas (pushing on the periorbit)
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| Pre-operative imaging |
Post-operative imaging |
This is an example of an olfactory groove meningioma positioned at the skull base in the anterior fossa. This patient was successfully treated with the expanded endonasal approach (EEA).
Embolization
In some instances, prior to surgery, a catheter may be inserted into blood vessels supplying the meningioma in order to disrupt the flow of blood to the tumor, causing it to shrink and making it easier to remove surgically.
Radiation Therapy
Radiation therapy is used either on its own or, more commonly, after surgery has been performed. If the tumor is not located in an area of the brain where surgery can be safely done, and the tumor is causing problems, radiation therapy is an effective way of treating the tumor and stopping its growth. If the tumor is confirmed to be malignant by pathology, radiation is generally always offered. In this case, radiation is given to help prevent the tumor from coming back.
Patients may receive 25 to 40 daily treatments or fewer treatments if stereotactic radiosurgery (Gamma Knife or CyberKnife) is prescribed.
Chemotherapy
Chemotherapy is used only in the treatment of malignant meningiomas, which are rare. Different medications are available and are generally used in conjunction with surgery and radiation therapy.
Prevention
There are no guidelines for the prevention of meningiomas.
This content was created by UPMC using EBSCO’s Health Library.