Brain & Spine Foundation

What is a meningioma?

Meningiomas are considered benign tumours, this means that they are not cancerous and therefore do not spread to other parts of the body. They are generally slow growing and can often reach a quite a large size before they are diagnosed. However, they can grow more rapidly or have growth spurts thus making it difficult to predict how fast they will grow. A meningioma can still cause damage to the brain even though it is benign. This is because the brain is encased in the skull and has very little space around it, as the tumour grows, the pressure can build up and squash the brain.

There is no known cause of meningiomas but certain conditions and situations are associated with an increased risk:

Some genetic disorders, for example, Neurofibromatosis type 2.
In people who have had radiation therapy to the head.
Exposure to female hormones and breast cancer.

Symptoms of a meningioma

There are a large number of symptoms that are associated with meningiomas. These may be due to irritation of the brain, an increase in intracranial pressure or due to the specific location where the tumour is growing. Some of the symptoms you may experience are headaches, seizures, visual changes, changes in personality, behaviour or mood or limb weakness.

Different types of meningioma

There are many different types of meningioma and their names often correspond with where on the brain and spine they occur.

Falx or parasaggital

The falx is the groove that runs between the two side of the brain from the front to the back. Parasaggital tumours lie close to the falx.

Convexity meningioma

These are often at the front of the brain. They grow on the surface.

Olfactory groove meningioma

These tumours grow on the nerves that go from the brain to the nose. Losing your sense of smell is one symptom of these tumours.

Sphenoid meningioma

These lie behind the eyes and can affect your vision

Skull based meningioma

These are located at the back of the skull. They can be difficult to operate on because important nerves and arteries are located here.

There are other types of meningioma located in different areas of the brain.

Diagnosis and treatment

Generally a CT scan or MRI scan is the first investigation people will have. This will show where the tumour is and how large it is. Meningiomas can have quite a distinct appearance on a scan but sometimes a biopsy will be needed. This is when a small amount of tissue is taken from the tumour and analysed under a microscope. A biopsy may be performed on its own or at the same time as a larger operation to remove the tumour.

If the meningioma isn’t causing any significant symptoms you will be monitored and given regular scans or scanned if your symptoms get worse. The ‘watch and wait’ option may also be preferable if the risks of the surgery outweigh the possible benefits.

Surgery to remove all or some of the tumour is the most common treatment. Surgery may not be possible if the tumour is in an area of the brain that is difficult to operate or if more problems will be caused by trying to remove it.

To remove the tumour the surgeon performs an operation called a craniotomy. A section of the bone is removed from the skull to allow the surgeon to remove the tumour, this is put back in place at the end of the operation. A small section of your hair will have to be shaved but the rest of you hair often covers this over. People stay in hospital for a week on average after the surgery. You may experience headaches and feel quite tired for a while afterwards but these should lessen with time.

You can read more about this operation in our Craniotomy fact sheet.

Radiotherapy

Meningiomas can also be treated with radiotherapy. This can be done with or without surgery. Sometimes you might be monitored after your surgery to see if the tumour is growing back before radiotherapy is considered.

The purpose of the radiotherapy is to shrink any remaining tumour or to stop/ slow down the rate at which is might grow back. Commonly, you will undergo treatment daily (called a fraction) for approximately 5-6 weeks, but each treatment only lasts a few minutes. Before the treatment starts, a mould will be made of you head. From the mould a clear Perspex or plastic mask will be made. You will wear the mask during treatment, it keeps you head still and in same position and enables marks to be made on shell instead of the skin to tell the radiographers where to direct the radiotherapy beams.

Side effects: Radiotherapy can make you feel quite tired and this may continue even after the treatment has stopped. You will experience some hair loss around the area which was treated and sometimes where the radiotherapy beams exit. The hair will grow back afterwards although it may not be as thick as it was before or it might be a slightly different colour

The skin around the area treated may become red or itchy. You should try to wear a hat when you go out in the sun as the skin is more sensitive.

Radiotherapy can make you feel sick, but there are quite a few different tablets you can take to control these symptoms.

Radiosurgery

This uses a highly focused beam of radiation which is directed at the tumour without affecting the normal surrounding tissue. The treatment is usually a single dose but sometimes more sessions are given for a large tumour or one that is located near to important structures, for example those responsible for vision. The majority of people do not experience any side effects but occasionally people report having a mild headache or dizziness for a short time. You won’t know immediately whether the treatment has worked as it takes 6-12 months for tumour to reduce in size. You will therefore be given regular MRI scans after the treatment to monitor the tumour. Radiosurgery isn’t suitable for meningiomas that are quite large (more than 3.5cm in diameter).

The treatment is also called gamma knife and is only offered at three centres in the UK:

Outcome

The majority of meningiomas do not reoccur but you will have regular scans to check if there has been any regrowth. After a period of time you may stop having scans and check ups completely.

The type of long term difficulties you may experience will depend partly on where the meningioma was located. Common problems include headaches and fatigue but you may also experience other difficulties including changes in your vision, memory or have weakness in your leg or arm.

A number of different health professionals can help you with these problems.

Clinical psychologist or neuropsychologist

They may perform a neuropsychological assessment to assess your intelligence, memory and other processes. They can also give therapy to help you cope with the problems you are having.

Physiotherapist

They can help with any difficulties you may be having with limb weakness, difficulty walking or lifting etc. Some physiotherapist specialise in neurology although most cover a range of medical conditions.

Occupational therapist

They can assess you to see if you might benefit from any adaptations to your home or special equipment. They can also help with practical skills such as managing money, coping with stress and anxiety.

Often people who have had a meningioma find it hard to explain to people that although they may look fine, they still have difficulty with certain things. It can be hard to cope with problems that are long term and you may feel frustrated and angry that you haven’t completely recovered. It often helps to confide in someone who understands how you feel. Keeping your thoughts and feelings bottled up inside of you can make everything seem worse. Try not to put too much pressure on yourself and do too much too soon. Do little and often and plan what you are going to do each day. You might find it helpful to keep a diary of how you are feeling. This can help you see that you are making small improvements week by week.

Meningioma