Meningioma Health Article

Diagnosis

Meningiomas are diagnosed using a painless, non-invasive technique called magnetic resonance imaging (MRI). MRI works by exposing the patient to harmless radio waves and a magnetic field, which produce clear images of the brain and the spine that show the size and location of tumors. No special preparation is required for the test.

Diagnosis can also be made by computed tomography (CT) scan. The CT scan uses low-dose x rays to generate a picture of the inside of the body. Sometimes a dye is injected into the patient's vein to improve the visibility of tissues. If the meningioma has grown into nearby bone, a CT scan will show the extent of bone invasion better than MRI. Women who are pregnant, or who think they might be pregnant, should tell their doctor before having a CT scan.

Treatment team

The treatment team for a patient with a symptomatic meningioma may include a radiologist, a neurologist (specialist of the nervous system), and a neurosurgeon.

If surgery is necessary, a neurosurgeon will perform the procedure with the help of a surgical team. The team includes two or three nurses, and an anesthesiologist.

A small number of patients receive radiotherapy for their meningioma either because the tumor is too difficult to remove surgically, or because the surgeon had to leave some tumor behind. These patients will be referred to a radiation oncologist (specialist in giving radiation to cancer patients).

Clinical staging, treatments, and prognosis

Staging

Meningiomas are classified into three different grades depending upon the likelihood of recurrence and aggressive growth:

• Grade I: Low risk of recurrence and slow growth
• Grade II: Greater likelihood of recurrence and/or aggressive growth
• Grade III: High recurrence rates and aggressive growth.

The vast majority of meningiomas are grade I. Atypical tumors are grade II, and malignant tumors are grade III.

Medical therapies

Medical treatment for meningiomas is necessary when tumors cause symptoms. Fortunately, only about a quarter of meningiomas become symptomatic. Most patients are cured by surgery.

The objective of surgery is to remove not only the entire meningioma, but also the tail that attaches the tumor to the meninges. If the tumor has grown into bone, the bone is removed, too. If the tumor is in a difficult location in the brain, the surgeon may leave some tumor behind in order to preserve brain tissue.

The prognosis following brain meningioma treatment is very good. For the few patients who are not cured, prognosis depends on how completely the tumor is removed. If some tumor is left behind, recurrence is more likely, particularly for patients with grade II or grade III meningiomas. Ten years after surgery, 7-20% of patients with benign grade I tumors have a recurrence. For patients with malignant grade III tumors, up to 78% have a recurrence. A second surgery is sometimes necessary for patients with recurrent tumors.

Spinal meningioma is the most successfully treated meningioma, and the most successfully treated of all spinal tumors. Most of these tumors are removed completely, and they rarely recur. Even patients with quite severe symptoms fully recover after surgery.

For the few patients who are inoperable (usually because of tumor location), radiation therapy can stop the growth of tumors. Recently, stereotactic radiosurgery has been successfully used. This procedure uses images of the patient's skull to construct a frame that allows precise aiming of radiation, thus minimizing harm to nearby healthy tissue.

Not every patient with a meningioma receives surgery or radiation. Asymptomatic patients with small or slow-growing tumors can receive periodic MRI tests to check tumor growth. Treatment may also not be necessary for patients with mild or minimal symptoms.

Alternative and complementary therapies

Unlike many other cancers, conventional medical treatment of meningioma has very high success rates. As a result, alternative therapies are not commonly used for these tumors.

Coping with cancer treatment

When first diagnosed with a meningioma, many patients experience anxiety, resulting in nervousness, sleepless nights, and even nausea. However, patients can often relieve many of their fears by learning more about the disease and its course of treatment.

The majority of meningioma patients are treated with surgery alone. Surgery will involve a hospital stay of at least a week. Before going home, patients are usually given medications to help prevent pain and swelling. Once home, patients can expect to feel some headache pain, and will become tired easily. If headaches and weakness become worse, a doctor should be contacted. Patients should make sure they get plenty of rest and eat a balanced, nutritious diet. Most patients can begin to resume their normal activities in about six to eight weeks.