Is this something inside your head? Let's learn about Meningioma in simple terms!

Have you ever thought that you might have a tumor growing inside your head? Doesn't that sound scary? But not all tumors are dangerous cancers . Today we're going to talk about a type of tumor that develops in the membranes surrounding our brain, which is usually benign, but sometimes requires a little attention. This is what doctors call a meningioma. Let's see what it is, why it develops, what are the symptoms, and how it is treated.

What is Meningioma? Simply put...

Think of our brain and the spinal cord (the nerve cord inside the spinal column) as valuable objects. So to protect these valuable objects, nature has given us three layers of covering. These coverings are called meninges . They are like the covers of a book.

So, this type of tumor called meningioma starts from the arachnoid cells (a type of cell in a thin membrane like a spider's web) in the meninges.

Most often, these meningiomas are found on the top of the brain and around the outer curvature. Sometimes they can also form at the base of the skull. However, meningiomas that form around the spinal cord are somewhat rare.

These tumors often grow slowly inward . So sometimes they are only discovered when they have grown to a large size. Even if they are benign, if they grow too large, they can press on important parts of the brain and even become life-threatening.

Are there grades of meningioma?

Yes, these nuts can be divided into three main categories based on their nature:

• Grade I or Typical: These are benign meningiomas . They grow very slowly. They account for about 80% of all cases.
• Grade II (atypical): These are not cancerous, but grow a little faster and are more resistant to treatment. About 17% of cases fall into this category.
• Grade III (Anaplastic): These are malignant meningiomas . They grow rapidly and can spread to other parts of the body. However, this type is very rare, occurring in only 1.7% of cases.

Are there types of meningiomas based on where they form?

Yes, these tumors are called by different names depending on where in the brain they form. Here are a few examples:

• Convexity meningiomas: These grow like the surface of the brain. As they grow, they can put pressure on the brain.
• Intraventricular meningiomas: These develop in the cavities inside the brain called ventricles, which are where cerebrospinal fluid (CSF) circulates.
• Olfactory groove meningiomas: These form at the base of the skull, between the brain and the nose. They can affect our olfactory nerve, which runs close to it.
• Sphenoid wing meningiomas: These form along a bony ridge behind our eyes.

In addition, there are about 15 types of meningiomas, depending on the type of cells seen under a microscope.

So is meningioma a cancer?

This is a problem that many people have. In most cases (about 80-85%) meningiomas are benign tumors. That is, they are not cancerous. However, as mentioned earlier, in some cases (Grade II and Grade III), they can be malignant.

The important thing is that even though meningioma is benign, if it grows large, it can press on and damage important nerves and structures in the brain. This can be life-threatening. Therefore, it is not something to be taken lightly.

Who is more likely to develop meningioma?

Meningiomas are most common in adults . They are very rare in children. They are usually diagnosed around the age of 66. Studies in the United States show that this condition is more common among black people than other ethnic groups.

Another thing is that women are more likely to develop meningiomas . This is thought to be due to the influence of female hormones. However, malignant meningiomas are more common in men.

How common is this situation?

Meningioma is a fairly common condition . It is estimated to occur in about 97 out of 100,000 people. That means that in the United States alone, more than 170,000 people are diagnosed with this condition each year. In fact, meningioma is the most common type of brain tumor.

What are the symptoms of meningioma?

Because meningiomas often grow slowly, they may not cause any visible symptoms until they are large enough to invade nearby vital structures. The symptoms depend on where in the brain the tumor is located.

For example:

• A person with olfactory groove meningiomas may have a partial or complete loss of their sense of smell. This is called anosmia .
• Meningiomas that form in the posterior frontal midline of the brain can cause paralysis of the legs and lower body. This is a condition called paraplegia .
• Sphenoid wing meningiomas can cause one or both eyes to protrude. This is called proptosis . It can also cause a condition called cavernous sinus syndrome .

These are some of the common symptoms that are usually caused by meningiomas in the brain:

• Headache (often worse in the morning)
• Dizziness
• Nausea and vomiting
• Vision changes (double vision, blurred vision, decreased vision)
• Hearing impairment
• Seizures
• Changes in behavior or personality (such as suddenly becoming angry or agitated)
• Memory problems
• Hyperreflexia (excessive increase in reflexes)
• Muscle weakness in some parts of the body
• Numbness in some parts of the body

If you have a meningioma in the spinal cord, the most common symptoms are:

• Pain where the tumor is located
• Radiculopathy ( pain, numbness caused by nerve root compression)
• Neurological disorders (weakness, decreased muscle tone - Hypotonia , decreased or absent reflexes - Hyporeflexia)

If you have one or more of these symptoms, it is very important to see a doctor as soon as possible.

What are the causes of meningioma?

Scientists still don't know exactly what causes meningiomas. However, research has found that between 40% and 80% of meningiomas have an abnormality in chromosome 22. This chromosome helps control the growth of tumors. This abnormality often occurs spontaneously. Rarely, it can be linked to inherited conditions.

Scientists have now identified several environmental, hormonal, and genetic risk factors for meningioma.

How is this meningioma diagnosed?

Meningiomas can sometimes be difficult to diagnose. Because they grow slowly, they may not cause symptoms until they are large enough to affect nearby areas. Also, because most meningiomas grow slowly and are more common in adults, some of the symptoms may be mistaken for normal aging.

If your doctor suspects that you may have a meningioma, he or she will refer you to a neurologist .

To diagnose a meningioma, your doctor will do a physical exam and a neurological exam. They may also recommend imaging tests such as:

• MRI (Magnetic Resonance Imaging) scan of the brain: This is the best imaging test to detect a meningioma. It is done by injecting a contrast material into a vein . An MRI scan is a painless test. It uses a large magnet, radio waves, and a computer to make clear pictures of the organs inside the body. The contrast material (which contains a rare metal called gadolinium) improves the quality of the pictures.
• CT (Computed Tomography) scan: If you can't have an MRI, your doctor will often order a CT scan with contrast . CT scans use X-rays and computers to make detailed pictures of structures inside the body. Contrast material (sometimes called dye) helps certain areas stand out in the pictures. This can be given as a drink or injected into a vein.

Sometimes, if there is any doubt about the diagnosis, a biopsy may be needed. This is to confirm whether it is a meningioma or something else. Your neurosurgeon will perform this biopsy and take a small tissue sample. The sample will be examined to determine what the exact disease is, whether the tumor is benign or malignant, and what grade it is.

What are the treatments for meningioma?

The treatment for meningioma varies from person to person . It depends on many factors. The treatment plan is often a combination of one or more of the following treatments:

• Observation ("Wait and see" method)
• Surgery
• Radiation therapy
• Palliative care
• Chemotherapy (this is rarely used in most cases)

Together, you and your medical team will determine the treatment plan that is best for you.

Observation ("watch and see" method)

There are several reasons why doctors use this "watchful waiting" approach:

• If you have no symptoms and the tumor is very small .
• If you have mild symptoms and there is no or very little swelling around the brain.
• If you have mild symptoms and you have had the cyst for a long time and it is not affecting your quality of life.
• If you are older and your symptoms are progressing very slowly .
• If treatment poses a significant risk to your health and life.

In such cases, your doctor will ask you to have repeat MRI scans and follow-up visits . Monitor the size of the tumor and your symptoms. Some tumors may not grow any larger.

Surgery

The main treatment for symptomatic meningiomas, or for large tumors that are likely to cause symptoms soon, is surgical resection .

Gross total resection (GTR) is a curative treatment for most people with meningiomas (70% to 80%) . The goal of surgery is to remove the tumor as completely as possible, but this may be limited by factors such as:

• Where the tumor is. (Some places are hard to reach)
• Whether the tumor is connected to brain tissue or surrounding blood vessels.
• Other factors that generally affect the safety of a surgical procedure.

The extent of the tumor removal greatly affects the likelihood of recurrence of meningioma in all grades treated with surgery.

Radiation therapy

Radiation therapy is a treatment that uses high-energy beams (radiation) to kill cancer cells or stop them from growing. It is also useful for some benign tumors, such as benign meningiomas.

Radiation therapy is used as a first-line treatment for meningiomas that cannot be completely removed, or in cases where the risks of surgery outweigh the benefits. Examples include meningiomas that are deep in the brain or that surround neurovascular structures.

There are several types of radiation therapy used to treat meningiomas:

• Stereotactic Radiosurgery (SRS): This is a non-surgical, high-intensity radiation treatment. It is used to treat brain tumors. It delivers high doses of radiation in fewer, more targeted doses with less damage to healthy tissue. It can be used for meningiomas at the base of the skull, meningiomas that have been partially removed, or meningiomas that are reoccurring.
• External Beam Radiation Therapy (EBRT): This is the most commonly used form of radiation therapy. High-energy radiation beams are directed directly at the tumor.
• Brachytherapy: This is a type of radiation therapy used to treat various cancers. In this, radioactive seeds or pellets are surgically placed inside or near the tumor.

Adjuvant radiotherapy for atypical and cancerous meningiomas can control tumor growth and increase the time the disease can return and overall survival. Adjuvant radiotherapy is a treatment that targets cancer cells that were not killed by the main treatment. Adjuvant radiotherapy, given after the atypical meningioma has been completely removed by surgery, can reduce the risk of the tumor coming back.

Palliative care

Meningioma and its treatment can cause physical symptoms and side effects, as well as psychological and social problems. Palliative care is the management of all these effects . This is an important part of your treatment plan. It is done in conjunction with treatments that are given to slow, stop, or eliminate the growth of the tumor.

Palliative care focuses primarily on managing symptoms, supporting you and your family, and improving how you feel during treatment . Palliative care treatments come in many forms. They may include:

• Medicines
• Changes in diet
• Relaxation techniques
• Mental and spiritual support
• Procedures that improve neurological function and quality of life
• Other treatments

Chemotherapy

Chemotherapy is a type of treatment that uses drugs to fight various types of cancer. Although chemotherapy is rarely used to treat meningiomas, doctors usually recommend it for people with meningiomas that are no longer responding to surgery or radiation therapy, or that have recurred or grown.

The chemotherapy drug Bevacizumab has been shown to be effective in shrinking tumors after surgery and radiation therapy for people with anaplastic meningioma.

Are there any side effects and complications of the treatment?

Treatments for meningioma can carry certain risks, side effects, and complications. It is important to talk to your medical team about the risks associated with your treatment plan.

Possible complications of meningioma surgery

Surgery to remove part or all of a meningioma is a complex procedure. It is not without its risks and complications. As with any surgery, there is a risk of infection and bleeding . Other possible complications include:

• Brain swelling after surgery, which can cause brain damage.
• Damage to the cranial nerves. Depending on where the meningioma is located, this can affect various functions, such as your vision, ability to move your face, and ability to swallow.
• Fluid accumulation around the brain (cerebral edema) after surgery can also cause brain damage.
• Accidental damage to healthy brain tissue. This can cause problems with your thinking, vision, and speech abilities.

Side effects of radiation therapy for meningioma

Although radiation therapy is not painful, there are some side effects that can occur when healthy tissue is exposed to radiation. The most common side effects of radiation therapy for meningioma are:

• Mild skin reactions and hair loss.
• Fatigue.
• Changes in thinking ability (such as difficulty thinking clearly, mild memory loss).
• The food is tasteless.
• Headache.

With the exception of symptoms related to thinking ability (which may be permanent), most of these side effects are temporary and usually resolve within a few weeks of treatment.

Side effects of chemotherapy for meningioma

The side effects of chemotherapy vary from person to person, depending on the type of drug given, and the dose. They may include:

• Hard work.
• Higher risk of infection.
• Nausea and vomiting.
• Hair loss.
• The food is tasteless.
• Diarrhea.

What are the risk factors for developing meningioma?

There are several risk factors for developing meningioma:

• Your age: Meningioma is most common in people 65 years of age or older. The risk increases with age.
• Your gender: Women are about twice as likely to develop meningiomas than men. Scientists think this is due to exposure to female sex hormones. Hormone replacement therapy and/or birth control pills, as well as having breast cancer, can also increase the risk.
• Exposure to radiation: The risk of developing meningioma may be increased if you have previously received radiation treatment to the head.
• Race/Ethnicity: In the United States, black people have a higher rate of meningioma than other ethnic groups.

In addition, there are genetic risk factors for meningioma. If you have any of the following conditions, or if someone in your immediate family (a sibling or parent) has had meningioma, you are at increased risk of developing meningioma:

• Neurofibromatosis Type 2: People with this condition are more likely to develop cancerous meningiomas or more than one meningioma.
• Von Hippel-Lindau disease .
• Multiple endocrine neoplasia type 1 .
• Li-Fraumeni syndrome .
• Cowden syndrome .

If you are concerned about your risk of developing a meningioma, be sure to talk to your doctor.

What can I expect if I have a meningioma?

This is very important. No two people with meningioma are affected in the same way. It's hard to say exactly how you will be affected. The best way to know is to talk to specialists who research and treat meningioma. They can give you a more accurate explanation of what to expect based on your specific situation.

What is the prognosis of meningioma?

The outlook for meningioma, that is, the likelihood of recovery and how the disease will progress, depends on several factors:

• The size of the tumor.
• Where the tumor is.
• Whether the tumor is benign or malignant .
• Whether the tumor was surgically removed partially or completely .
• Your age and overall health.

If you are an adult, your age at diagnosis is the strongest predictor of outcome. In general, the younger you are, the better your outlook. The best outcome is when the tumor can be completely removed surgically. However, depending on the location of the tumor, this may not always be possible.

Meningiomas can recur after treatment. The recurrence rate depends on how much of the tumor was surgically removed. The recurrence rate is low if it is completely removed.

A meningioma and its treatment can cause long-term complications , for example:

• Difficulty concentrating.
• Memory loss.
• Personality changes.
• Seizures.
• Weakness.
• Language problems (difficulty speaking and understanding).

What is the survival rate for meningioma?

The five-year survival rates for meningioma are as follows:

• Grade I tumor: 95.7%
• Grade II tumor: 81.8%
• Grade III tumor: 46.7%

Ten-year survival rates for meningioma:

• Grade I tumor: 90%
• Grade II tumor: 69%

The ten-year survival rate for malignant meningioma is gradually increasing due to new treatments .

It's important to remember that these figures are just general estimates . Only your doctor can give you a more informed outlook based on your specific situation.

When should you see a doctor about meningioma?

If you have been diagnosed with meningioma, and you experience new symptoms or changes in existing symptoms , you should let your doctor know as soon as possible.

If you have been treated for meningioma, your care does not end after active treatment ends. Your medical team will continue to check for recurrence , manage long-term side effects, and monitor your overall health.

What questions should I ask my doctor?

If you are diagnosed with a meningioma, it may be helpful to ask your doctor these questions:

• What type of meningioma do I have?
• What is the grade of the fruit? What does it mean?
• How many people with these tumors do you treat per year?
• Is my family at increased risk of developing meningioma?
• Do you have any reading materials that will help me understand this disease?
• What are my treatment options?
• What clinical trials can I participate in?
• What treatment plan do you recommend for me? Why?
• What support services are available to me and my family?
• Do you know of a support group for people with meningioma?
• If I have questions or concerns, who should I talk to?

Finding out you have a brain tumor, whether it's benign or cancerous, can be a shock. But the good news is that meningioma is a treatable condition with a generally good outlook. Your healthcare team is here to provide you with strong, personalized treatment options and support. If you have any questions or concerns, don't be afraid to ask your healthcare team. They are here to help.

Final Take-Home Message

So, we've talked a lot about meningioma, haven't we? Simply put, it's a tumor that develops in the membranes that cover our brain and spinal cord (the meninges). Most of the time, these are benign (not cancerous) , and they grow slowly. That's why sometimes it takes a while for symptoms to appear.

However, if you have symptoms like headaches, vision changes, or seizures, you should definitely seek medical advice. This can be detected with things like MRI and CT scans. Treatment depends on the nature, size, and location of the tumor, and sometimes involves just observation, or surgery or radiation therapy.

The most important thing is not to be afraid, not to panic, and to follow the correct medical advice. Not all meningiomas are the same, so doctors will determine the treatment that best suits your situation. If you have any questions, never hesitate to ask.

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