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Meningioma – Causes, Symptoms and Treatment

A meningioma is a usually benign tumor arising from the meninges, the membranes surrounding the brain and spinal cord. It often grows slowly and may cause no symptoms.

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Things worth knowing about "Meningioma"

A meningioma is a usually benign tumor arising from the meninges, the membranes surrounding the brain and spinal cord. It often grows slowly and may cause no symptoms.

What Is a Meningioma?

A meningioma is a tumor that originates from the meninges – the protective membranes covering the brain and spinal cord. Meningiomas are among the most common primary brain tumors, accounting for approximately 36–40% of all intracranial tumors. In around 80–90% of cases, they are benign (non-cancerous) and grow slowly, displacing rather than invading surrounding tissue. Atypical and malignant forms are considerably rarer.

Causes and Risk Factors

The exact cause of meningiomas is not fully understood. The following factors are known to increase risk:

Radiation exposure: Prior radiation therapy to the head is a well-established risk factor.
Genetic predisposition: People with Neurofibromatosis type 2 (NF2) have a significantly higher risk of developing meningiomas.
Hormonal factors: Meningiomas are more common in women, suggesting a role for female sex hormones such as estrogen and progesterone.
Age: The risk increases with age, particularly after the age of 60.

Symptoms

Many meningiomas produce no symptoms and are discovered incidentally during imaging for unrelated conditions. When symptoms do occur, they depend largely on the tumor location:

Headaches (often worse in the morning)
Seizures
Visual disturbances or hearing loss when located near relevant cranial nerves
Personality changes or cognitive difficulties
Weakness or numbness in the arms or legs
Balance and coordination problems

Diagnosis

Meningiomas are primarily diagnosed through neuroimaging:

Magnetic Resonance Imaging (MRI): The gold standard for visualizing the tumor, its size, and its relationship to surrounding structures.
Computed Tomography (CT): Useful for assessing bony involvement or calcification within the tumor.
Biopsy: A tissue sample may be taken during surgery to confirm the diagnosis histologically and determine the tumor grade.

The WHO classification distinguishes three grades: Grade I (benign), Grade II (atypical), and Grade III (malignant or anaplastic). This grading is essential for treatment planning.

Treatment

Watchful Waiting

Small, asymptomatic meningiomas may be managed with regular MRI surveillance rather than immediate intervention. Many of these tumors show minimal or no growth over several years.

Surgical Removal

Neurosurgical resection is the primary treatment for symptomatic or growing meningiomas. Complete surgical removal offers the best chance of cure. However, the feasibility and risk of surgery depend on the tumor location and its proximity to critical brain structures.

Radiation Therapy

Radiation therapy is used when surgery is incomplete, not feasible, or when the tumor recurs. Options include conventional fractionated radiotherapy and radiosurgery (e.g., Gamma Knife or CyberKnife), which delivers a high dose of radiation precisely to the tumor.

Medical Therapy

There is currently no established drug therapy for meningiomas. However, clinical trials are investigating chemotherapy and targeted agents for high-risk or recurrent cases.

Prognosis

The prognosis for benign meningiomas (WHO Grade I) after complete surgical removal is generally excellent. The recurrence rate depends on the extent of resection and the tumor grade. Atypical and malignant meningiomas carry a worse prognosis and require closer long-term follow-up.

References

Louis DN et al. – The 2021 WHO Classification of Tumors of the Central Nervous System. Acta Neuropathologica, 2021.
Goldbrunner R et al. – EANO guidelines on the diagnosis and treatment of meningiomas. Neuro-Oncology, 2021.
National Cancer Institute (NCI) – Meningioma Information. www.cancer.gov, accessed 2024.

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