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What do I have?
Meningiomas are tumors that arise from the meninges, the layer of cells that cover the brain and spinal cord. In their most common form, they represent a benign, non-cancerous tumor. However, in rare cases they can degenerate into a cancer. Because meningiomas arise separate from the brain itself, they usually display a very sharp border between the brain and tumor both on MRI imaging (picture) and on microscopic appearance (picture). The microscopic appearance of the tumor determines its grade, a measure of how cancerous the tumor is. The majority of meningiomas are grade I, benign tumors, but occasionally can be grade II (atypical) or grade III (malignant) which are more cancerous. (pictures)
What does it do?
Meningiomas compress parts of the brain or spinal cord as they grow, often achieveing great size before they put enough pressure on the brain or spine to cause any symptoms at all. Typical symptoms a patient might notice include headache, seizure, visual loss, loss of sense of smell, loss of hearing, and loss of coordination from brain miningiomas. In spinal meningiomas, difficulty walking and clumsiness in the hands will typically be among the first things patients notice. Very rarely, a large tumor can cause a stroke.
How long have I had it?
While it is impossible to know for sure how long a tumor has been present for any one person, we do know that most meningiomas are very slow growing tumors. In some cases we follow patients for many years without any sign of tumor growth (picture) and it is not unreasonable to assume that most patients will have had a tumor present for many years before it is found medically. Occasionally though, tumors can be stimulated to grow more rapidly. We think that this may be due to hormonal changes or other growth signals that stimulate the tumor.
Can it be cured?
The majority of meningiomas can be cured or controlled through a combination of surgery and radiation therapy. The mainstay of therapy for meningiomas is surgical removal. Because meningiomas arise from the covering over the brain, rather than the brain itself, they can usually be successfully removed through an operation known as a craniotomy. The type of craniotomy and approach used by the surgeon to access and remove the tumor depends on its location in the brain, with the risks of surgery generally increasing for larger tumors and for tumors that grow closely to critical brain structures such as major blood vessels and nerves. In some instances the risk of injuring these critical structures may prevent a surgeon from removing a tumor in its entirety.
In the event that a tumor can’t be removed completely or for small tumors that are found asymptomatically, another approach that is very successful uses stereotactic radiosurgery with tumor control rates >90%. Additional radiation and/or chemtherapy is sometimes also prescribed for tumors in the grade II or grade III classes if they fail to respond or are resistant to surgery and radiosurgery.
In addition, sometimes very small tumors require no treatment at all. It is not uncommon to find tumors on CT or MRI scans that are ordered for other reasons. If the tumor is small and is not causing any symtoms, doctors may decide to just take pictures of it every 6-12 months to make sure its not growing and hold off on any surgery or treatment until the tumor shows signs that it is actively getting bigger.
What caused it?
Most meningiomas are sporadic or random diseases. In rare circumstances they can be part of an inherited tumor syndrome such as Neurofibromatosis or can be associated with exposure to radiation such as was given in the 1950’s to control head lice in some countries. Overall 99% of meningiomas probably represent pure chance. There does not appear to be any link to smoking, diet, or other lifestyle risks that are associated with other types of tumors.
- May arise from previous treatment with ionizing radiation or excessive x-ray exposure
- Can occur at any age
- Twice more common in women than in men
- Accounts for 27% of all brain tumors
- Women with meningiomas can experience growth during pregnancy.