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Meningioma by Michelle Badash, MS

Definition

The meninges are a protective lining around the brain and spinal cord. A meningioma is a tumor of these linings. Most meningiomas do not cause symptoms. But, if the meningioma grows, it can push on important parts of the brain. This may lead to symptoms such as vision problems, seizures, weakness, or language problems. These tumors may be grade I, II, or III. Type III is the most aggressive type.

Malignant meningiomas (also called anaplastic or grade III) are less common. These tumors are faster growing. They often cause problems and can cause some swelling in the brain.

Some meningiomas may require some form of therapy, surgery, and/or radiotherapy. The treatment will depend on the location of the tumor.

Meningioma

Causes

The exact cause of meningiomas is unknown. Factors that may be associated with these tumors include:

Genetic predisposition
Certain hormones—may increase the growth of meningiomas.

Risk Factors

Factors that may increase the risk of meningioma include:

Sex: 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 (NF2)
Radiation exposure, especially to the head

Symptoms

Symptoms of meningioma are usually related to the area of the brain that is affected. Symptoms can also be due to an increase in the pressure inside the skull. Symptoms may include:

Headaches
Vomiting
Visual problems
Changes in behavior
Seizures
Pain
Loss of sensation or weakness in the arms and legs
Loss of bladder or bowel control
Slurred speech
Language deficits
Difficulty with learned movements
Loss of coordination
Difficulty writing
Cognitive difficulty

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. You will have a neurologic examination. 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

MRI of Meningioma in the Brain

Treatment

Treatment will depend on the size and location of the tumor, its rate of growth as well as your general health. The main types of treatment for meningiomas are:

Surgery

Surgery may be recommended if the tumor is located in an area that is easily reached. Most surgeries can be done without causing neurologic damage.

Embolization

Tumors need a blood flow to survive. In some instances, prior to surgery, a catheter may be inserted into blood vessels supplying the tumor. It will disrupt the flow of blood to the tumor. This will make the tumor shrink. The smaller tumor can then be removed with surgery.

Radiation Therapy

Radiation therapy is used either on its own or after surgery has been done.

Some tumors may be located in an area the is difficult or to dangerous to operate on. Radiation may be used on its own if the tumor is causing symptoms and cannot be removed with surgery. The radiation therapy is an effective way of treating the tumor and stopping its growth.

If the tumor is higher grade, radiation is generally considered. In this case, radiation may be given either on its own or after surgery to help prevent the tumor from coming back.

Your radiation oncologist will describe how the therapy is delivered and how many treatments are needed. You may receive 25-40 treatments on a daily basis, or far fewer treatments if you are having stereotactic radiosurgery. This type of surgery delivers higher doses of radiation each treatment.

Chemotherapy

Chemotherapy is used only if other treatment modalities are no longer adequate. Your oncologist will discuss the options and choice of medications.

Prevention

There are no guidelines for the prevention of meningiomas.

RESOURCES:

National Brain Tumor Society http://braintumor.org/
National Cancer Institute http://www.cancer.gov/

CANADIAN RESOURCES:

Brain Tumor Foundation of Canada http://www.braintumour.ca/
The Canadian Brain and Nerve Health Coalition http://www.ccns.org/index.html

References:

Greenberg HS. Meningiomas. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation. Available at: http://www.medlink.com . Accessed March 17, 2007.
Meningioma. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 18, 2012. Accessed August 31, 2012.
Meningioma. International radiosurgery association website. Available at: http://www.irsa.org/meningioma.html . Accessed August 31, 2012.
Keller A, Ludwig N, Comtesse N, et al. H-P A minimally invasive multiple marker approach allows highly efficient detection of meningioma tumors. BMC Bioinformatics. 2006,7:539

Last reviewed September 2012 by Rimas Lukas, MD

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