Meningioma
Overview
Meningiomas are one of the most common types of brain tumors. They arise from the meninges - the lining of the brain and spinal cord. They can occur virtually anywhere along this lining and the location determines what symptoms are caused. They are typically benign but can occasionally be malignant. For larger tumors with significant mass effect, the treatment is maximal safe surgical resection. This may be followed by radiosurgery or radiation therapy in selected cases.
Symptoms
Meningiomas cause symptoms by compression and/or irritation of adjacent brain or cranial nerves. The location of the tumor and its size determine the symptoms. Common symptoms can include headaches, seizures, weakness, numbness, loss of the sense of smell, personality changes, double vision, visual loss, facial pain, and hearing loss. Other than seizures, symptoms onset is usually insidious, taking place over months to years.
Treatments
There are three options for most meningiomas: Observation, Surgery and Radiation. Surgery is indicated for symptomatic tumors of any size that can be safely removed or for tumors demonstrating significant growth. Radiation is an option for tumors that cannot be removed with surgery, for small areas of tumor that remain after surgery, for higher grade tumors and for patients who are medically too frail to undergo surgery. Stereotactic Radiosurgery is a special type of high-dose focused radiation that is delivered primarily to the tumor with little spread to the surrounding brain or cranial nerves. It is best for smaller tumors. Observation is chosen for smaller tumors that are not causing symptoms and not growing rapidly.
FAQ
- Please make sure that you either bring all MRIs and CT scans of your brain with you or, preferably, that they are sent to our clinic in advance. Our office staff can assist you with this.
- Bring a friend or family member. It always helps to have another set of ears.
- Write down any questions you have in advance.
Case Studies
Case Studies
Case 1: 57-year-old woman with several year history of progressive headaches, balance problems, and cognitive decline. MRI (Fig.1) demonstrated a large meningioma located in the pineal region with significant mass effect on the brain stem. She underwent endovascular embolization of the tumor to block off part of its blood supply followed by craniotomy (open brain surgery) for removal of the tumor. Her postoperative MRI 3 years later demonstrates no evidence of recurrent or residual tumor (Fig. 2)
Outcome: Pt had very good clinical outcome with complete resolution of her preoperative symptoms.
Case 2: 57-year-old woman who presented with visual loss. MRI (Fig. 3) demonstrated a meningioma sitting just above the pituitary gland causing compression of the optic nerves. She underwent an endonasal endoscopic approach for complete removal of the tumor (Fig. 4). {Click here to see a video of the surgery}.
Outcome: Pt had excellent return of her vision and did well from the surgery.
Case 3: 55-year-old woman with balance problems, facial numbness and swallowing difficulties. MRI (Fig. 5) demonstrated a large meningioma with severe mass effect on the brain stem. Patient underwent a 2 day surgical procedure consisting of a skull-base presigmoid approach on the first day and resection of the tumor on the second day. Small regions of the tumor were very adherent to the basilar artery, a critical blood vessel supplying the brainstem (Fig. 6). These areas of tumor were left behind and treated subsequently with external beam radiation therapy.
Outcome: Patient is doing well. She has very mild residual weakness of the left side but walks without any assistance or device. Her swallowing, balance and facial numbness have all markedly improved compared to her preoperative state.