Meningioma

Specialized Treatment at our Premier Brain Tumor & Neuro-Oncology Center

The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health offers state-of-the-art treatment for brain, spinal, and intracranial tumors through a multi-disciplinary approach. The neurology and neurosurgery department has a team of board-certified neurologists, neurosurgeons, neuro-oncologists, and support staff working to treat patients with meningiomas with compassionate care. In up to 85% of cases, meningiomas are curable through surgery.

Meningiomas grow very slowly over time, and many patients don’t notice symptoms for years. You should seek immediate medical care if you suspect you have a meningioma, as these tumors can cause disability. Seek emergency care if you have a sudden onset of seizures, rapid changes in vision or memory, or headaches worsening over time.

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What Is a Meningioma?

Meningiomas are so named because they originate in the meninges, or the membranes surrounding the brain and spinal cord. Every year, about 6,500 people are diagnosed with these slow-growing, usually benign tumors. They account for more than one-third of primary brain tumors, making meningiomas the most common primary brain tumor, according to the Brain Science Foundation. Primary brain tumors are those which originate in the brain rather than spreading from another part of the body to the brain. Because meningiomas originate on the surface of the brain, they are technically not brain tumors, because they do not grow within the brain itself. However, because a meningioma is encased in the skull and can compress the brain, nerves, and blood vessels, it is considered an intracranial tumor.

It is important to note that while most meningiomas are “benign” (non-cancerous), it does not mean they are harmless. In fact, meningiomas can kill if left untreated, as they can cause brain hernia, which leaves a person in a vegetative state if they survive. Even if a person doesn’t have severe complications, meningiomas can cause serious impairment. Tumors can grow to the size of a golf ball before they are detected, which seriously compresses the brain and impairs function in the affected area.

Meningioma Grades

Meningiomas are classified by grade, which indicates their level of malignancy (cancerous traits found in the cells), if any. They are further classified by location in the brain, which determines the treatment course. The World Health Organization (WHO) classifies by grade 1 (benign), grade 2 (atypical – a combination of benign and malignant traits), and grade 3 (malignant, or cancerous). More than 90% of meningiomas are benign, 7% are atypical, and very rarely they are malignant.

Common Symptoms Caused by Meningioma Tumors

Signs of a meningioma develop slowly over time, because the tumor grows so slowly, and symptoms are barely noticeable until the tumor is quite large. Some people do not notice symptoms at all, and only discover they have a meningioma when receiving a brain scan for some other condition.

Across all types of meningiomas, general symptoms include:

  • Frequent headaches, worsening over time
  • Personality changes or behavior more noticeable over time
  • Problems with vision, sense of smell, and hearing
  • Memory loss
  • Nausea and vomiting
  • Confusion
  • Persistent sleepiness
  • Weakness or numbness in the limbs
  • Seizures

Meningioma Subtypes and Their Symptoms

Like all brain tumors, meningiomas have multiple subtypes based on where the tumor is located.

Symptoms associated with the following meningioma subtypes include:

  • Convexity Meningioma: These grow on the surface of the brain, and usually have no symptoms until they reach a large size.
  • Foramen magnum meningioma: Located in the area where the spinal cord connects to the brain, they can cause headaches and difficulty walking due to brain stem compression.
  • Intra-orbital meningioma: Grow around the eye sockets, causing excess pressure on the eyes. Symptoms include a bulging appearance of the eyes and vision problems, including possible blindness.
  • Intraventricular meningioma: These are located in the cerebrospinal fluid-filled brain ventricles. They can cause a buildup of fluid in the head, called hydrocephalus. Common symptoms are headaches and dizziness.
  • Olfactory groove meningioma: Grow along the nerves running between the brain and the nose. They often cause a loss of smell, and visual problems if the optic nerve is compressed. Patients may exhibit personality changes.
  • Parasagittal/falx meningioma: Grow between the dura fold which runs between the left and right hemispheres of the brain. Those affected may have personality changes, headache, vision problems, difficulty with reasoning and memory skills, and weakness or numbness in the limbs.
  • Petrous ridge meningioma: Located in the portion of the temporal bone, which supports the temples. This can affect hearing ability.
  • Posterior fossa meningioma: Grow on the underside of the brain near the brainstem and cerebellum. These tumors can cause hearing loss. They can also cause trigeminal neuralgia, a condition resulting in extreme facial pain and sometimes facial spasms.
  • Sphenoid meningioma: Grow along the bony ridge behind the eyes. They can cause visual problems and facial numbness.
  • Spinal meningioma: Located in the thoracic spine (where the spine connects to the ribs), these cause back pain which worsens at night, and numbness or paralysis of the legs.
  • Suprasellar meningioma: These affect the pituitary gland and cause hormonal disturbances.
  • Tuberculum sella meningioma: Grow near the optic nerves and pituitary gland and cause visual field disturbances.

Risk Factors for Meningioma Tumors

The causes of most brain tumors are unknown. However, certain risk factors put people at a higher risk of developing a meningioma, including:

  • Sex: Females are more than twice as likely to develop a meningioma than males, per the American Association of Neurological Surgeons. Men, however, are three times as likely to have a malignant meningioma versus females.
  • Age: Meningiomas are most common in adults over the age of 60, but can occur at any age.
  • Exposure to ionizing radiation: High doses of radiation have been associated with a higher incidence of intracranial tumors, especially meningiomas. Dental x-rays are a common source of ionizing radiation, but many dentists have turned to digital radiographs to replace traditional dental x-rays, which have minimal radiation.
  • Breast cancer: The Brain Science Foundation’s research has suggested a possible correlation between breast cancer and meningiomas.
  • Diagnosis of neurofibromatosis 2 (NF2): This genetic disorder puts individuals at a higher risk of developing a meningioma tumor, or multiple meningiomas. People with NF2 are also more likely to develop a malignant meningioma.
  • Obesity: A higher body mass index (BMI) is an established risk factor for meningiomas in several large studies, but the exact relationship between the two is unknown.

Meningioma Diagnosis

Because symptoms are often very subtle, meningiomas can go unnoticed or misdiagnosed. Even a qualified physician can mistake the symptoms of a meningioma for other health conditions or write it off as normal signs of aging. Meningiomas are often diagnosed incidentally when performing a brain scan for a condition affecting the head, such as a head injury. A primary care doctor may refer you to a neurologist to determine whether you have a brain tumor, if one is suspected.

Diagnosis involves imaging tests, including computerized tomography (CT) and magnetic resonance imaging (MRI) scans. MRI scans are most effective, because they are the best tool to display the details of the brain. A CT scan can be useful to evaluate if any of the skull bone is involved, or if the tumor has calcified.

The only way to make a definitive diagnosis is through biopsy of the cells found in the tumor. Simply locating the tumor in the brain is insufficient for definitively diagnosing a meningioma. A neurosurgeon performs the biopsy, and a pathologist makes a diagnosis to determine whether the tumor is benign or malignant, and grade it accordingly.

Meningioma Treatment

The decision to treat a meningioma or simply to observe it (the “wait and see” approach) depends on factors such as the size and location of the tumor, its rate of growth, and the patient’s age, overall health, and treatment goals.

Observation/“Wait and See”

Not all meningiomas require immediate treatment, especially if the risks of treatment outweigh the suspected benefits. Observation may be appropriate for a period of time if the patient has minimal symptoms that do not affect their quality of life. If the patient does not wish to proceed with surgery, symptoms may be managed through medication, such as for any seizures or headaches.

Surgery

Most meningioma tumors have defined borders, are benign, and can be completely removed through craniotomy surgery. Other tumors are highly complex to remove and require more than one surgical procedure to completely extricate. Craniotomy surgery involves the opening of the skull to allow the neurosurgeon full access to the meningioma. A portion of the meningioma tumor tissue will be tested for biopsy and then classified by a pathologist according to grade.

Minimally-invasive surgical options include endoscopic removal, keyhole microsurgical removal, endoport removal, and others. The goal of the surgery is to preserve and/or improve neurological function.

Radiosurgery

If a meningioma cannot be treated through traditional surgery, or if a portion of the tumor is inoperable, radiosurgery may be necessary. Tumors which through go through the falx – the dividing line between the left and right brain hemispheres – are often treated through radiosurgery. Radiosurgery involves the delivery of high-energy x-rays to the tumor to kill cancer cells in order to shrink tumors.

Radiosurgery options include:

  • Standard external beam radiotherapy
  • Proton beam treatment
  • Sterotactic radiosurgery (such as Gamma Knife®, Cyberknife®, or Novalis)

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