Meningioma

A meningioma is a tumour that has grown from the tissues that line the brain, called meninges. The vast majority of meningiomas are entirely benign (WHO grade I) and usually grow as a lump compressing the adjacent brain. Occasionally they may also invade the skull bone and they may compress or wrap themselves around blood vessels or nerves in the head. They produce symptoms like other brain tumours.

Is it a malignant tumour (cancer)? Can it be cured?

Most meningiomas are completely benign (grade I) but rarely they can behave more like a malignant tumour, invading adjacent tissues and growing rapidly (atypical – grade II or anaplastic – grade III). Most meningiomas can be cured, but this depends on their location and involvement of other tissues or structures.

What is the best treatment for my meningioma?

The best treatment for a meningioma depends on a number of factors, including:

  1. Location – if the tumour is easily accessible then it is often best for it to be removed if it is causing symptoms.
  2. Size – if the tumour is less than 3cm in diameter it may alternatively be possible to treat it with stereotactic (targetted) radiosurgery.
  3. Symptoms – if your tumour is not causing any symptoms and is small, you may not require any treatment at all.
  4. Your general health - for example there may be risks with a general anaesthetic in patients with other significant medical conditions such as heart disease.
  5. Grade of tumour – you may be offered conventional radiotherapy after surgery if your meningioma is grade II or III. Chemotherapy is only rarely used.

The best treatment, therefore, varies from one patient to another. For some patients there may be no need for any treatment at all; in others it may be advisable to have a combination of treatments, such as surgery, radiosurgery, radiotherapy and chemotherapy.

Who decides on the best treatment for me?

The optimal treatment for each patient is now determined by a panel of specialists in most neurosurgical units in the UK. This panel (multi-disciplinary team - MDT) will consist of  neurosurgeons (with specific expertise in brain tumours), neuro-oncologists (specialists in radiotherapy and chemotherapy for brain tumours), neuroradiologists (specialist in interpreting brain scans) and neuropathologists (make the diagnosis by examining the biopsies under the microscope). This opinion will be discussed with the patient by his treating doctors (often a neurosurgeon initially) but ultimately, only the patient can decide which treatments he wishes to undergo.

What is the prognosis of meningiomas?

For tumours treated by surgery, the prognosis (likely outcome of treatment) depends primarily on the extent of the surgical resection, which is largely determined by the location of the tumour. If it was possible for your surgeon to remove all of the tumour with a margin of normal meninges around it, then it is very unlikely to recur. In cases where it is not possible to remove the entire tumour and its origin, the chance of recurrence is higher. The likelihood of recurrence is also influenced by grade; with the rare grade II and III tumours more likely to re-grow.

For tumours treated with stereotactic radiosurgery there is also a very high chance of tumour control (‘cure’). Your surgeon will be able to give you a more precise indication of the likelihood of recurrence or cure.