Meningioma Treatment Options
Meningioma treatment depends on the tumor’s size, location and growth. While surgery is often preferred, other treatments like radiation and medication can help manage symptoms or control the meningioma if surgery isn’t viable.
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Overview of Treatment Options
Treatment options for meningiomas depend on several factors, including tumor size, location and growth rate. Doctors will consider the tumor’s grade and the patient’s health when creating a treatment plan.
While surgery is often the preferred strategy for removing meningiomas, other options like radiation or medications might be used for symptom control or if surgery is impractical.
Factors Influencing Treatment: Size, Location and Other Factors
The size and location of the meningioma play a role in determining treatment options. Surgery is usually the best protocol, but doctors might recommend options like radiation therapy if surgery isn’t in your best interest.
- Tumor grade
- The World Health Organization classifies meningiomas into three categories. These include Grade 1 (benign and slow-growing), Grade 2 (atypical and more concerning) and Grade 3 (malignant or cancerous and aggressive). This helps doctors determine the most appropriate treatment, with higher-grade tumors requiring more intensive care.
- Tumor growth rate
- How quickly a tumor grows, tracked by several MRI scans over time, helps doctors decide if urgent treatment is needed or if it’s better to monitor the situation.
- Patient age and overall health
- The patient's age and overall medical condition influence treatment options since they impact the risks and benefits of interventions. For example, older patients might not need treatment because the tumor may not grow enough to affect their quality of life. This can differ for younger patients.
- Extent of tumor removal
- If doctors cannot completely remove the meningioma during surgery, the patient may need additional treatment, like radiation therapy.
- Previous radiation exposure
- Radiation exposure, especially as a child, could increase the chances of developing a meningioma later in life. This past exposure can also impact treatment options.
- Recurrence risk
- The chances of a tumor returning are greater in Grade 2 and 3 meningiomas. This can influence the treatment plans after surgery, including the use of radiation therapy.
Treatment Goals: Symptom Relief vs. Tumor Removal
The treatment goals for meningiomas can be categorized into symptom relief and tumor removal or control, each with distinct objectives and strategies.
Symptom relief focuses on easing problems caused by a meningioma, while tumor removal or control involves surgery and other methods to eliminate the tumor. Choosing between these approaches depends on your specific situation and health.
Symptom Relief
Meningioma symptom relief aims to ease tumor-related problems like headaches and seizures. Doctors may use a “watch and wait” approach with slow-growing meningiomas that don’t cause symptoms, monitoring the meningioma using regular imaging.
If surgery isn’t viable, especially for tumors near critical brain areas, radiotherapy can help control symptoms, and medications may be prescribed for issues like seizures or swelling. This approach focuses on improving your quality of life when surgical risks outweigh the benefits or the tumor isn’t significantly impacting your health.
Tumor Resection and Control
The main goal in treating and controlling meningiomas is to remove as much of the tumor as possible to prevent it from growing back. The primary treatment is surgery, but complete removal may not be feasible due to the tumor’s location.
If the entire tumor can’t be removed, doctors may use methods like radiation or new targeted therapies to control its growth. Taking a biopsy could help determine the best treatment, especially for meningiomas that may require chemotherapy because they aren’t receptive to surgery or radiation.
Surgical Treatments for Meningioma
Surgery is usually the best option for treating most meningiomas. This is particularly true for large tumors that grow rapidly or cause symptoms. Your doctor may use other treatment options along with surgery.
According to UCLA Health, up to 85% of meningiomas in favorable locations are curable with surgery alone.
When Is Surgery Recommended?
Surgery is typically the best treatment for meningiomas, particularly when the tumor is resectable. This can often cure benign tumors. However, the decision to operate depends on factors like the tumor type and your health.
- Location of the meningioma
- Size of the meningioma
- Whether you are experiencing symptoms
- Your age
- Your overall health
- Your personal preferences for treatment
For older patients or tumors in sensitive areas, doctors may recommend radiation therapy instead. If a meningioma isn’t causing symptoms, doctors often suggest monitoring it rather than immediately treating it through surgery or other strategies.
Ultimately, the choice to have surgery should be made collaboratively between you and your doctor, considering your preferences and health status.
Types of Meningioma Surgery
The method for meningioma surgery depends on different factors, such as the tumor’s size, location and proximity to critical nearby structures such as nerves or parts of the brain.
- Craniotomy
- This is a common surgical approach. It involves making a temporary window in the skull to access and remove the meningioma. After tumor removal, the surgeon repairs the skull opening.
- Pterional (fronto-temporal) craniotomy
- This approach may be necessary for medial sphenoid wing meningiomas, requiring a larger opening in the skull. The pterional craniotomy is a popular brain surgery technique that lets doctors access important areas of the brain without having to push on brain tissue.
- Minipterional craniotomy
- A minipterional craniotomy is a less invasive variation of the standard pterional craniotomy involving a smaller incision. This allows access to the skull base and minimizes brain retraction, reducing complications.
- Endoscopic endonasal approach
- Using the endoscopic endonasal approach, a surgeon can safely remove certain types of tumors at the base of the skull, particularly those near the optic nerve. In this minimally invasive procedure, a tiny endoscopic camera and surgical device are inserted through the nostril to remove the tumor. This technique avoids pulling brain tissue and protects the optic nerve.
- Supraorbital eyebrow approach
- The supraorbital eyebrow approach is a surgical technique used for meningiomas near the optic nerves and pituitary gland. It is minimally invasive, causing less damage to healthy tissue and allowing for a direct route to the tumor. This method often uses a tiny camera called an endoscope for better visibility during the procedure.
Doctors may use advanced tools and technologies to help make the surgery more effective. These can include special maps showing the brain’s layout during surgery, monitoring systems that check how the nerves function in real-time and imaging techniques that provide pictures of the treated area.
Radiation Therapy for Meningioma
Radiation therapy can be vital for treating meningiomas. It damages the tumor’s DNA, causing it to shrink and reducing symptoms. Different techniques, like intensity-modulated radiation therapy, proton therapy and stereotactic radiosurgery, can be tailored based on the tumor’s size and location.
How Radiation Works: Types and Effectiveness
Doctors may use radiation therapy, also known as radiotherapy, as a primary treatment for meningiomas. It can also help destroy remaining abnormal cells after surgery.
Radiation therapy uses powerful energy beams to harm meningiomas’ DNA. This stops the tumor cells from growing and can cause them to die off, which shrinks the tumor and may ease symptoms by reducing pressure on nearby parts of the brain or spinal cord.
Various types of radiation therapy are options for meningioma treatment, each implementing a distinct delivery method.
- Intensity-Modulated Radiation Therapy
- Intensity-modulated radiation therapy can target cancers with unusual shapes or locations near important organs using computer-controlled beans that are adjustable in shape and strength. This is valuable because it minimizes damage to healthy tissues nearby, reducing the chances of side effects.
- Proton Radiation Therapy
- Unlike traditional ionizing radiation, this method uses proton beams, which can be more effective for tumors located deep within the skull or near its base.
- Stereotactic Radiosurgery
- Though it has "surgery" in its name, this is a non-surgical treatment. This procedure focuses narrow beams of high-intensity radiation on a small area, minimizing impact on surrounding tissue. It is handy for meningiomas in high-risk or inaccessible areas.
- Fractionated Stereotactic Radiation Therapy
- Similar to stereotactic radiosurgery but administered over several days, this approach allows for higher doses with reduced risk to healthy tissue.
According to a 2022 study in the Journal of Neuro-Oncology, radiotherapy is a key treatment for meningioma. The study’s authors found it was safe and effective as the primary or secondary treatment after surgery.
As we learn more about these tumors, we can personalize treatments better, helping doctors assess risks and choose the best approaches for each patient.
Stereotactic Radiosurgery: Benefits and Limitations
Stereotactic radiosurgery has emerged as a significant treatment for meningiomas, especially for patients who can’t have traditional surgery or have tumors in challenging locations. Its precision, safety and ease of use make it increasingly popular in brain tumor care.
According to UCLA Health, 80% of meningiomas can have their growth stopped using stereotactic radiosurgery. A 2023 study in the Journal of Neurosurgery puts the tumor control rate at 92% for large perioptic meningiomas — tumors that grow near the optic pathway.
Stereotactic radiosurgery is a treatment option that avoids surgery for small meningiomas or tumors near critical brain areas. The Journal of Neurosurgery study found that a type of stereotactic radiosurgery called gamma knife radiosurgery effectively targeted larger meningiomas near the eyes while protecting vision pathways.
Other Non-Surgical Treatment Options
Aside from radiation therapy, other non-surgical alternatives for meningiomas include chemotherapy, though it is rarely used and typically reserved for cases where surgery or radiation are ineffective.
There is no standard chemotherapy or medicine-based treatment for meningiomas. However, researchers are exploring targeted therapies to improve outcomes.
Alternative treatments like acupuncture, meditation, massage and relaxation exercises can help manage the side effects of treatment. While none of these treat the meningioma or slow its growth, they can support overall well-being and enhance quality of life.
Recovery and Long-Term Management
Regardless of the treatment you receive for a meningioma, you will have a recovery period and long-term monitoring for recurrence. Rehabilitation and continued observation can look different depending on your side effects and signs of recurrence.
Physical Rehabilitation and Cognitive Therapy
Meningioma treatments can cause neurological and cognitive impairments. Physical rehabilitation and cognitive therapy play critical roles in recovery and long-term management following treatment.
Physical and Occupational Rehabilitation
After treatment for meningioma, physical therapy focuses on improving your balance, strength and ability to move around. Customized exercises that build muscle and improve coordination help achieve this.
Occupational therapy can help you regain your independence in everyday activities like getting dressed, cooking and running errands. Therapists may suggest tools to assist with walking and strategies for managing tiredness and discomfort.
These therapies are tailored to meet your recovery goals, making returning to your usual routines easier and enhancing your overall quality of life.
Cognitive Therapy
Cognitive rehabilitation can help you recover your thinking and memory skills after treatment for meningioma. This type of therapy uses simple techniques, like memory aids and breaking down tasks into smaller steps.
The main goal is to improve attention, memory and focus through various exercises that stimulate different parts of the brain.
Programs can be customized, focusing on enhancing everyday activities and overall quality of life. You’ll work closely with psychologists and therapists to establish personal goals, and they often use tests to assess progress and guide the rehabilitation process.
Monitoring for Recurrence
Tumors may recur after surgery and may happen months or years after the initial diagnosis. A 2024 study in the Journal of Neuro-Oncology found that 10% to 32% of intracranial meningiomas recur within 10 years.
Post-treatment monitoring is crucial. You’ll likely have scans every six months to a year in the first few years. If you remain stable, the time between scans might increase. Sometimes, doctors perform a biopsy to check for tumor recurrence and gather details to determine the best treatment options.
If the meningioma returns, your treatment options may be similar to the original meningioma.
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