Meningioma Brain Tumor

A meningioma is a tumor that arises from a layer of tissue (the meninges) that covers the brain and spine.

Meningiomas grow on the surface of the brain (or spinal cord), and therefore push the brain away rather than growing from within it.
Most are considered benign because they are slow-growing with low potential to spread.
Meningioma tumors can become quite large. Diameters of 2 inches (5 cm.) are not uncommon. Meningiomas that grow quickly and
exhibit cancer-like behavior are called atypical meningiomas or anaplastic meningiomas, and are fortunately rare. Meningiomas
represent about 20 percent of all tumors originating in the head and 10 percent of tumors of the spine.
About 6,500 people are diagnosed with meningiomas each year in the United States. This type of tumor occurs more frequently in
people with a hereditary disorder called neurofibromatosis type 2 (NF-2).
Possible Symptoms Caused by a Meningioma
The most common symptoms are pain (headache) for weeks to months, weakness or paralysis, visual field reduction and
speech problems.
Specific symptoms depend upon the location of the tumor.
Most Common Sites and Symptoms for Meningiomas in the Head:
Location MRI Image Common Symptoms
Convexity (on the surface
of the brain away from the
midline)

Seizures, headache, extremity weakness,
difficulty speaking, visual field deficit.
Parafalcine (arising the
meningeal layer between
the hemispheres of the
brain)

Seizures, lower extremity weakness,
headache, personality changes,
dementia, increasing apathy, flattening of
affect, unsteadiness, tremor.
Sphenoid Ridge

Eye-bulging, decreased vision, paralysis
of eye movement, seizures, memory
difficulty, personality change, headache.
Posterior Fossa (area
where the cerebellum is)

Unsteadiness and incoordination,
hydrocephalus (increased pressure
inside the brain), voice and swallowing
difficulties.
Cerebellopontine angle (on
the side of the brainstem)

Loss of hearing. Facial muscle
weakness. Dizziness. Unsteadiness and
incoordination, hydrocephalus (increased
pressure inside the brain), voice and
swallowing difficulties.
Olfactory Groove and sella
(bony space where the
pituitary gland is situated)

Loss of smell (anosmia), subtle
personality changes, mild difficulty with
memory, euphoria, diminished
concentration, urinary incontinence,
visual impairment.
Optic Sheath Decreased vision in one eye.
Other Variable depending on location.

Diagnosis
Magnetic resonance imaging (MRI) scans effectively detect most meningiomas and are best at displaying details of the
brain.
Sometimes a CT scan is obtained to evaluate whether there is any bone (skull) involvement, or if the tumor is calcified.
Treatment
The decision of whether to, and how best to, treat a meningioma is based on multiple factors, including size and location of the
tumor, symptoms, growth rate, and age of the patient (among others). In general, there are three basic options: observation, surgical
removal, and radiation.
Observation: Meningiomas are often slow growing, increasing is size only 1-2 mm per year. Repeating yearly MRI scans
may be appropriate in the following situations:
o Patients with small tumors and mild or minimal symptoms, no impact on quality of life, and little or no swelling in
adjacent brain areas.
o Older patients with very slowly progressing symptoms. Related seizures can be controlled with medication.
Surgery: Meningioma surgery varies from relatively straightforward to highly complex, sometimes requiring multiple
surgeons from different specialties.
o The ease of removal depends upon both their accessibility and the skill of the neurosurgeon. UCLA brain tumor
neurosurgeons have extensive experience in removing all types of meningiomas.
o The goals of surgery are to:
obtain tissue to confirm the diagnosis
meningiomas are classified by pathologists into three types:
Grade 1 - Benign: These very slow-growing tumors account for 75 percent of all
meningiomas.
Grade 2 - Atypical: Usually slow-growing but can recur.
Grade 3 - Anaplastic: More malignant, faster-growing.
The 15 percent of meningiomas that recur often progress to a higher grade. Grade 2 and 3
tumors recur more frequently than grade 1 types
remove sufficient tumor in order relieve pressure or distortion of the normal brain tissue
When total removal of the tumor carries significant risk of morbidity (any side effect that can
decrease quality of life), its better to leave some tumor tissue in place
If the tumor invades any of the large draining veins, major arteries on the brain surface, or if
it is on the underside of the brain, chances of a complete resection decrease and risk of
complications increases.
preserve and/or improve neurological function
if possible and safe, remove all the tumor so that it will not grow back.
Meningioma tumors that are near the surface and have not invaded deep structures or
major blood vessels are more likely to be totally removed safely.
Minimally invasive surgical
Endoscopic removal of meningiomas through the nose
o olfactory groove meningiomas
o tuberculum sella meningiomas
o sellar meningiomas

Keyhole microsurgical removal using eyebrow incision
o olfactory groove meningiomas
o sphenoid wing meningiomas

Endoport removal
o intraventricular meningiomas

Tumor embolization prior to surgery
o In some cases, your surgeon may choose to reduce the blood supply to the tumor by ordering an embolization
procedure.
o Embolization involves threading a thin tube (catheter) up the leg veins or arteries directly into the blood vessels
that feed the tumor. Then a glue-like clotting substance is injected to choke off and shrink the tumor.
Radiation
o For those ineligible for surgery or with incomplete surgical removal, either conventional radiation or
fractionated stereotactic radiosurgery (radiotherapy) can slow or stop the growth of meningiomas.
o Radiation treatment is often considered for deep, surgically inaccessible tumors, or tumors in elderly patients.
Younger patients (< 50 years of age) need to be counselled about the risk of developing radiation-
induced cancer 10 or more years after radiation treatment. Fortunately, the chances of this
happenning appear to be very small.
o Meningiomas have sharp margins and rarely invade neighboring tissue, thus they are ideal tumors for focused,
shaped radiation fields using the Novalis Shaped-Beam
Surgery.
This technique does not require actual surgery,
but instead uses advanced imaging and
computer technology to deliver a high dose of
radiation to the tumor while limiting radiation
exposure to the surrounding brain structures.
For many meningioma tumors, the radiation field needs to be conformed to the shape of the tumor. In
addition, delivering the radiation in smaller doses over a period of weeks will reduce the risk of
injuring critical brain structures next to the tumor (which may cause blindness, deafness, paralysis).
Some treatment techniques, such as the Gamma Knife, cannot deliver this type of treatment.
UCLA neurosurgeons helped develop the Novalis Shaped-Beam Stereotactic System, one of the
most advanced conformal stereotactic radiation delivery system in the world.
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Prognosis
Surgery
o For tumors in favorable locations, up to 85% of meningiomas are curable with surgery.
o Location, the amount of the tumor left after surgery, and the skill of the neurosurgeon are the important
elements in predicting a successful result.
Radiation
o Stereotactic radiosurgery stops the growth of meningiomas in up to 80 percent of cases.