Meningioma

Definition

MRI of meningiomaMeningiomas are very common and represent 30% of all brain tumors. Meningiomas do not originate from the brain tissue itself but arise from the meninges (the three membranes that surround the brain and spinal cord).

The vast majority of meningiomas (90%) are benign and are unlikely to spread throughout the body like cancer. They usually have a slow growth rate. However, they can cause serious neurological deficits and require treatment due to encroachment on the brain and critical neurovascular structures nearby. Treatment options include surgery, radiation, and less commonly, chemotherapy.

Skull base meningiomas can be particularly difficult to treat due to their location and proximity to critical brain structures. The physicians at the UF Health Comprehensive Skull Base Surgery Center work with a team approach to manage these complex tumors. Using leading-edge surgical techniques, including endoscopic approaches, radiation strategies and novel medical therapies, UF Health physicians are helping patients achieve cures.

Causes and Risk Factors

It isn’t clear what causes meningiomas. However, there are several risk factors associated with this type of tumor.

  • Radiation exposure – Radiation to the head may increase a person’s risk of developing meningioma, including exposure as a child. Accidental exposure to radiation and radiation therapy as a treatment for ringworm on the scalp (tinea capitis) are common sources of radiation that can cause meningioma.
  • Genetic disorders – Those with neurofibromatosis (NF) type 1 or 2 have a higher risk of developing meningioma. Those with NF2 are also more likely to develop cancerous meningioma or more than one meningioma (meningiomatosis).
  • Gender – Although men and women are just as likely to be diagnosed with cancerous meningioma, women are approximately twice as likely as men to develop noncancerous meningioma. Meningiomas can have estrogen/progesterone receptors, indicating a possible association with the growth of meningiomas.

Several studies have examined possible links between cell phone use and tumors, most of them centering on brain tumors. The data is mixed and most conclude that they are not associated with meningioma growth. Currently, the American Cancer Society (ACS) does not have any official position or statement on whether or not radiofrequency (RF) radiation from cell phones, cell phone towers or other sources is a cause of cancer.

Symptoms

Meningiomas may not present any significant signs or symptoms because many times they grow slowly. Small ones may not produce any symptoms, while larger ones can result in seizures or other serious issues. The type of symptom may also depend on its location.

Symptoms for meningiomas may include:

  • Seizures
  • Headaches
  • Weakness
  • Numbness
  • Vision problems
  • Hearing difficulties
  • Facial movement difficulties
  • Swallowing difficulties

Exams and Tests

Many meningiomas are found incidentally when imaging scans are obtained for a headache/head injury, stroke, trauma or sinus problems. If a physician suspects a meningioma, he/she will diagnose by conducting a neurological exam followed by an imaging test (CT scan or MRI scan).

Treatment

Meningioma patients at UF Health benefit from the experience of our neurosurgeons, who see over 2,600 brain tumor patients per year and perform state-of-the-art techniques for treatment.

Treatment for meningiomas is often:

  • Observation (regular MRIs or CTs)
  • Surgical resection
    • Special techniques include
      • Awake cortical mapping for tumors in eloquent areas
      • Fluorescence-guided surgery
      • Use of intraoperative MRI to ensure all of the tumor is removed
      • MRI-guided laser ablation (LITT) with Neuroblate system
      • Radiation
        • Stereotactic radiosurgery (SRS)
        • Conformal fractionated radiotherapy
        • Proton beam radiotherapy

Many of these treatment options have been developed or refined through the scientific research efforts at the University of Florida, and UF is a destination site for the surgical or radiosurgical treatment of meningiomas. Clinical trial options for patients can be discussed with neuro-oncology.

UF Health employs a team-based approach. Patients are seen by experts in neurosurgery, radiation oncology, neuro-oncology and ENT with input from neuroradiology, neuropathology and medical physicists to ensure patients are treated with the best possible combinations of available therapies. Tumors are often sent for genetic sequencing for a personalized medicine approach.

Outlook (Prognosis)

The outcome with meningiomas is dependent on the tumor grade, size and location. A grade I tumor grows slowly, while a grade II tumor grows more quickly, and a grade III tumor grows and spreads very quickly. For most tumors, the lower the grade, the better the prognosis.

Larger tumors of the skull base can often have high recurrence rates and require further treatment with radiation or by neuro-oncology. Also, meningiomas have different mutations, which can predict outcomes.

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