What Is Meningioma?
Meningiomas are tumors that develop in the meninges, which are the protective layers surrounding the brain and spinal cord. While most meningiomas are benign, their location may cause significant symptoms depending on the pressure they exert on nearby tissues, organs and nerves.
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Meningioma Overview: Types and Classifications
A meningioma is a type of tumor that forms in the layers covering the brain and spinal cord, known as the meninges.
Meningiomas can press on nearby brain tissue, nerves and blood vessels, causing multiple neurological problems. Headache, dizziness, weakness, memory problems and changes in vision are among the more common symptoms, but meningiomas can also lead to loss of smell, paralysis of the lower body or even bulging eyes. Meningiomas are the most common primary tumors found in the brain, making up about 30% of all cases.
Benign vs. Malignant Meningiomas
- Benign (Grade I)
- Atypical (Grade II)
- Malignant (Grade III)
Benign meningiomas are the most common and least threatening, accounting for 78% to 81% of cases. They tend to be slow-growing and less invasive.
Atypical meningiomas are mid-grade tumors, making up roughly 18% of meningioma cases. They grow faster than benign meningiomas and have a higher chance of recurrence after removal.
Malignant meningiomas are the rarest and most aggressive. They are fast-growing tumors with a high rate of recurrence.
| Comparison | Benign | Atypical | Malignant |
|---|---|---|---|
| Growth Rate | Grows slowly. | Grows faster than benign meningiomas. | Grows at a much faster rate than benign and atypical meningiomas. |
| Invasiveness | Has distinct borders and typically does not invade nearby tissue. | Often characterized by brain invasion. | They tend to invade parts of the brain near the tumor. |
| Cellular Appearance | Cells show minimal abnormalities when viewed under a microscope. | Increased tissue and cell abnormalities. | Cells show increased abnormalities. |
| Recurrence | Less likely to recur after treatment. | They tend to recur more often than benign meningiomas. | Higher likelihood of recurrence. |
| Frequency | Accounts for up to 81% of all meningiomas. | Accounts for 15% to 20% of meningiomas. | Accounts for only 1% to 4% of meningiomas. |
| Treatment | Surgery to remove the meningioma, potentially followed by radiation therapy. Then, ongoing surveillance with MRI scans. | Surgery, possibly followed by radiation treatment if the whole meningioma is not removed. | Surgery to remove all or as much as possible of the meningioma, followed by radiation therapy. |
| Survival Rates (5-year and 10-year progression-free rates) | 5-year rate: 95.7%
10-year rate: 90.47%. | 5-year rate: 81.8%
10-year rate: 69.4% | 5-year rate: 46.7%
10-year rate: 58% |
Meningioma: Primary vs. Secondary Brain Tumors
Primary brain tumors form in the brain, its nerves or the layers surrounding it. Meningiomas are a common type of primary brain tumor and are typically benign and grow slowly. However, they can occasionally be malignant (cancerous). Most frequently, they are found in individuals assigned female at birth, making them unique among brain tumors.
Secondary brain tumors (or brain metastases) spread to the brain from other areas of the body. These tumors are malignant, often originating from cancers of the lungs, breasts, kidneys, skin (melanoma) or colon.
Common Symptoms of Meningioma
Meningiomas can cause various symptoms based on their location and size. Depending on the tumor’s location, symptoms may develop gradually and vary widely.
Some meningiomas, especially if they are small or slow-growing, may not cause any noticeable meningioma symptoms.
- Changes in eyesight, including double vision or blurred vision
- Convulsions
- Decreased sense of smell
- Difficulty with speech
- Diminished hearing or tinnitus
- Forgetfulness
- Headaches
- Loss of strength in the arms or legs
- Numbness
- Seizures
If you experience persistent or worsening neurological symptoms, you should talk to your doctor or other health care professional.
Progressive Symptoms and Complications
Getting help right away is essential if you’re experiencing meningioma symptoms. Otherwise, the tumor can grow, causing additional symptoms and other health complications.
Early diagnosis can improve your meningioma treatment options, potentially allowing for less complicated procedures and helping avoid serious problems.
- Increased Pressure in the Head:
- This may cause swelling of the optic nerve, which could impair vision.
- Build-Up of Fluid in the Brain:
- This condition, known as hydrocephalus, occurs when the fluid in the brain doesn't drain properly.
- Nerve Problems:
- Depending on the tumor’s location, it might impact different nerves. This could cause issues like tingling or numbness in the face, trouble controlling facial muscles or difficulties moving the eyes.
- Changes in Thinking and Memory:
- If the tumor affects the front part of the brain, it may lead to problems with thinking, memory and overall mental health.
- Difficulty With Movement:
- Some people might experience trouble walking, shaking or a loss of fine motor skills, like difficulty writing.
- Foster-Kennedy Syndrome:
- This rare complication may arise from tumors in a specific area of the brain, leading to a loss of smell, swelling in one eye or damage to the optic nerve.
While these issues might occur, many meningiomas grow slowly. Some people may not show any symptoms for a long time. Regular check-ups and timely treatment can help manage these tumors and prevent severe complications.
When doctors can identify the tumor quickly, they can better understand its seriousness and develop an appropriate treatment plan. This gives patients a better chance for a good recovery and may improve their well-being by lowering their odds of experiencing severe symptoms.
Causes and Risk Factors for Meningioma
Meningiomas occur due to changes in your genes, specifically involving chromosome 22. While scientists don’t fully understand why they develop, they know a few key points.
For example, these tumors are more common in middle-aged women and people over the age of 65.
Additionally, certain factors can increase your chances of getting a meningioma. These include having had radiation treatment for head issues, using hormone replacement therapy, taking hormonal birth control or having specific genetic conditions.
Genetic Predispositions
Genetics can greatly influence the risk of getting meningiomas. One particular condition, Neurofibromatosis type 2 (NF2), is the most common genetic risk for meningiomas.
NF2 is a hereditary genetic disorder transmitted from one generation to the next by a parent. People with NF2 have a 50% likelihood of passing the mutated gene to their child. Between 50% and 75% of people with NF2 syndrome will develop a meningioma.
- BAP1 tumor predisposition syndrome
- Cowden syndrome
- Multiple endocrine neoplasia type 1 (MEN1)
- Nevoid basal cell carcinoma syndrome
- Rubinstein-Taybi syndrome
- Werner syndrome
Each of these conditions involves genetic factors that can increase the likelihood of getting a meningioma.
Environmental Triggers
Exposure to certain types of radiation, especially high doses, is the biggest environmental factor that increases your chance of developing a meningioma. In fact, this is the only clear environmental risk linked to these tumors.
If you receive a lot of ionizing radiation, your risk of getting a meningioma could increase by six to ten times.
- Therapeutic radiation to the head and neck
- Atomic bomb exposure
- Dental X-rays, notably full-mouth series and panoramic radiographs
Researchers have looked at other environmental factors for their potential impact, but the results are not clear or consistent. These include:
- Occupational lead exposure
- Frequent, long-term cell phone use
- Exposure to vinyl chloride and certain other chemicals
- Electromagnetic field exposure
While researchers have studied these factors, their association with meningioma risk is not as established as ionizing radiation exposure.
Drugs That Can Cause Meningioma
Several prescription drugs are linked to an increased risk of meningiomas, particularly when used at high doses or for prolonged periods. These include:
- Depo-Provera (medroxyprogesterone acetate):
- This is an injectable contraceptive for women. According to a 2024 study in the British Medical Journal, prolonged use results in a 5.6-fold increased risk of intracranial meningioma. Since the study’s publication, there’s been a steadily rising number of Depo-Provera lawsuits.
- Surgestone (promegestone):
- Promegestone can be a treatment option for menopausal hormone therapy and may help with specific women's health issues. Long-term use is associated with a 2.7-fold increased risk of intracranial meningioma.
- Androcur (cyproterone acetate):
- Cyproterone acetate treats conditions related to hormones, including acne, excessive hair growth, early puberty and prostate cancer. It's also a key part of hormone therapy for transgender individuals and is commonly found in birth control pills. High doses are associated with an increased risk of meningioma.
- Lutenyl or Zoely (nomegestrol acetate):
- Nomegestrol acetate is a progestin. It's frequently found in birth control pills and can be used to help with symptoms during menopause or treat certain women’s health issues. Prolonged use may increase the risk of meningioma.
- Belara (chlormadinone acetate):
- Chlormadinone acetate is a hormone commonly found in birth control pills. It can also be part of hormone therapy for women going through menopause and helps treat other women's health issues like endometriosis. Long-term use is associated with a substantial increase in meningioma risk.
The risk of developing meningiomas increases with the dosage and how long you take specific medications. Generally, using higher doses or for a longer duration of time means a higher risk.
Diagnosis and Treatment Options for Meningioma
Doctors typically diagnose meningiomas using advanced imaging methods like MRI scans. These scans give clear pictures of the tumor, showing its size, location and how it affects nearby tissues.
Treatments vary based on the tumor’s features and the patient’s overall health. Options can include surgery to remove the tumor or other methods like radiation therapy that don’t require surgery.
By using these techniques, healthcare providers can ensure that each patient gets a precise diagnosis and a treatment plan tailored to their specific needs.
Diagnostic Imaging and Biopsies
Diagnostic imaging is crucial for identifying and planning the treatment of meningiomas. MRI scans using a special dye called gadolinium are generally the best way to get clear images of these tumors. Taking a biopsy (tissue sample) is usually unnecessary.
MRI scans provide high-quality pictures that show fine details. They can reveal how the tumor is growing, whether it’s affecting nearby blood vessels or structures and how it interacts with the surrounding areas. This helps doctors decide on the best course of action.
- Initial Detection
- Many meningiomas are found by chance during CT or MRI scans for other medical reasons.
- Diagnosis
- Doctors can usually accurately identify a meningioma using CT scans and MRIs. While MRI scans can often give clues about the tumor's type, they don't always reveal its seriousness. In those scenarios, a biopsy is necessary.
- Treatment Planning
- Imaging helps doctors visualize a tumor’s location in relation to nearby organs and tissues. This information is critical for planning surgery.
- Monitoring
- Imaging techniques can help monitor meningiomas, especially in asymptomatic patients. These scans help doctors track tumor size over time, whether during treatment or observation.
- Differentiating Grades
- New imaging methods are helping doctors distinguish between high-grade and low-grade meningiomas. Key features, like an uneven edge where the tumor meets the brain and its pattern of contrast uptake, can effectively identify more aggressive, high-grade tumors.
However, in some cases, a biopsy may be necessary to confirm a meningioma diagnosis.
- It can be challenging to take a tissue sample for testing when a tumor is in a hard-to-reach area of the body, like the brain. This makes it difficult for doctors to determine the severity of the meningioma through a biopsy.
- Doctors can often identify a meningioma by looking at images from scans. This means they usually don’t need to take a tumor sample for testing, making the diagnosis process simpler in many cases.
Surgical vs. Non-Surgical Treatment
There are surgical and non-surgical options available to treat meningiomas. Approaches depend on the tumor’s size, location, growth rate and the patient’s health.
Surgical Treatment
Meningioma surgery involves removing as much of the tumor as possible. For accessible meningiomas, gross total resection can cure 70% to 80% of cases. However, deeply located or skull base tumors may prevent complete removal.
Advanced surgical techniques include minimally invasive endoscopy and fluorescent dyes that help ensure thorough tumor resection.
Non-Surgical Options
Doctors may use non-surgical treatments after or in addition to meningioma surgery. They might also consider these options if surgery isn’t possible or is too risky. Sometimes, doctors may just monitor slow-growing tumors that aren’t causing problems.
Radiation therapies are another option. These methods, like stereotactic radiosurgery, target the tumor directly to try to shrink or stop it from growing. Stereotactic radiosurgery is precise and often used for tumors that doctors can’t surgically remove or if they recur after surgery.
Chemotherapy isn’t a standard treatment for meningiomas, but it can be an option for aggressive tumors that keep coming back.
Additionally, palliative care is an important aspect of treatment that focuses on managing symptoms and improving patients’ overall quality of life during their treatment.
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