Meningiomas are the most common primary brain tumours. The tumours are very rarely cancerous. These tumours arise from the meningeal covering of the brain, namely from the arachnoid layer.
These tumours are named on the location of their origin and sometimes can become very large in size.
Risk factors for a meningioma include:
- Radiation treatment. Radiation therapy that involves radiation to the head may increase the risk of a meningioma.
- Female hormones. Meningiomas are more common in women, leading doctors to believe that female hormones may play a role. Some studies have also suggested a link between breast cancer and meningioma risk related to the role of hormones. Some research suggests that the use of oral birth control and hormone replacement therapy could raise the risk of meningioma growth.
- An inherited nervous system disorder. The rare disorder neurofibromatosis 2 increases the risk of meningioma and other brain tumors.
- Obesity. A high body mass index (BMI) is an established risk factor for many types of cancers, and a higher prevalence of meningiomas among obese people has been observed in several large studies. But the relationship between obesity and meningiomas is not clear.
- Weakness in hands or legs
- Difficulty in walking
- Memory disturbance
- Hearing loss
- Vision loss
- Scalp swelling or growth
- Weakness in legs or bowel or bladder problems in spinal meningiomas
- Headaches with vomiting
- Visual complaints
- Loss of consciousness
MRI brain with contrast is the best modality of diagnosis of these tumors. Certain cases may also require CT scan or angiography for surgical planning or treatment.
Treatment for Meningioma
1: Wait and Watch:
Small tumours or calcified tumours which may have been picked up on imaging done due to some other reason , especially in the elderly may be just kept under observation. Some of them may not show any growth and may not need any treatment.
2. Surgery :
Craniotomy and excision is the preferred treatment of choice in the majority of cases. Surgery depends on the location of the tumours and can be quite complicated. These tumours can sometimes grow very large in size and surgeries can be quite complex and demanding. Some tumours or locations may not allow complete removal and partial decompression may only be done
Modern tools such as Neuronavigation, intra op imaging, intra op neuromonitoring help make surgery safer and help in more complete removal of the tumour.
Spinal meningiomas are treated with laminectomy and removal of the tumours. These tumours though small can present with significant weakness in the body due to their location
Some tumours which may have destroyed the skull bone or have come out in the scalp may need complex reconstruction of the skull or face with the help of a plastic surgeon.
3. Radiosurgery (SRS) / Gamma Knife:
Certain tumours which may be small in size, or in dangerous locations may be treated with SRS. Residual tumours after surgery may be treated with radiosurgery .
4. Radiation therapy
Tumours which are high grade , or tumours which can not be removed surgically may be treated with radiotherapy to control their growth.
Treatment of these tumours can be quite complex and difficult and may need multi modality care .
Meningiomas can be classified into 3 grades. Grading can only be done after surgical removal of the tumour of biopsy from the tumour. Treatment options and outcome depends on the grade of tumours.
The most common grade. Majority of meningiomas will fall into this category. These are generally slow growing tumours which can cause symptoms due to their location and size. These meningiomas can be cured after total removal during surgery. Cases where surgery maynot be an option or where total removal is not feasible may be treated with SRS or radiotherapy.
Atypical meningiomas are mid-grade tumours. This means the tumours have a higher chance of coming back after being removed. These tumours will be generally given radiotherapy after removal to reduce the chances of recurrence.
Anaplastic meningiomas are malignant (cancerous). This means they are fast-growing tumours. These tumours can be quite aggressive and grow rapidly and need to be treated with surgery, radiation and chemotherapy. They have a very strong tendency to recur and may need multiple surgeries.
As these tumours arise from the covering of the brain most of them cause symptoms due to pressure and size. Once removed most patients can recover completely and live a normal healthy life.
Very large tumours can be removed safely and cured with current surgical techniques and methods.
Large parasagital meningioma
Large pterional menigioma
Large intraventricular meningioma removed using minimally invasive transportal technique
Tumor coming out of the skull causing growth and swelling
Large olfactory groove meningioma