MeningiomaA meningioma is a type of tumor that develops from the meninges, the membrane that surrounds the brain and spinal cord. There are three layers of meninges, called the dura mater, arachnoid and pia mater. Most meningiomas (90%) are categorized as benign tumors, with the remaining 10% being atypical or malignant. However, the word "benign" can be misleading in this case, as when benign tumors grow and constrict and affect the brain, they can cause disability and even be life threatening.
In many cases, benign meningiomas grow slowly. This means that depending upon where it is located, a meningioma may reach a relatively large size before it causes symptoms. Other meningiomas grow more rapidly, or have sudden growth spurts. There is no way to predict the rate of growth for a meningioma, or to know for certain how long a specific tumor was growing before diagnosis.
Most people with a meningioma will only have a tumor at only one site, but it is also possible to have several tumors growing simultaneously in different parts of the brain and spinal cord. When multiple meningiomas occur, more than one type of treatment may have to be used.
Meningiomas vary in their symptoms and appropriate treatment options depending on where they are located.
A primary brain tumor originates in the central nervous system, while metastatic brain tumors spread to the brain from other parts of the body. Meningiomas account for about 27% of primary brain tumors, making them the most common of that type.
Who Is At Risk?
Meningiomas are most common in people between the ages of 40 and 70. They are more common in women than in men. Among middle-aged patients, there is a marked female bias, with a female: male ratio of almost 3:1 in the brain and up to 6:1 in the spinal cord. Meningiomas are very rare in children, with pediatric cases accounting for only 1.5% of the total.
How Is The Diagnosis Made?
Meningiomas may cause seizures, headaches, and focal neurological defects, such as arm or leg weakness, or vision loss. Patients often have subtle symptoms for a long period before the meningioma is diagnosed. Sometimes memory loss, carelessness, and unsteadiness are the only symptoms.
Diagnosis is made by a contrast enhanced CT and/or MRI (magnetic resonance imaging) scan. While MRIs are in some ways superior, the CT can be helpful in determining if the tumor invades the bone, or if it’s becoming hard like bone.
Treatment OptionsMany patients with meningioma have no symptoms. For these patients, carefully watching the tumor is often appropriate. Evidence from studies which track patients for many years suggest that as many as two-thirds will not have symptoms over time. If the tumor is pressing on surrounding tissue, with or without symptoms, the treatment of choice is usually to surgically remove the tumor (resection).
Initial Treatment Steps
- Steroid medications may be needed to reduce swelling and inflammation of brain tissue.
- Anticonvulsant medications may be prescribed to help control seizures.
- A shunt may be inserted if the tumor has resulted in a buildup of fluid in the brain (hydrocephalus). A shunt is a long, thin tube that is placed in the brain and then threaded under the skin to another part of the body, usually the abdomen. The tube allows excess fluid from the brain to drain into the abdominal cavity where it is reabsorbed.
Several treatment options are available to reduce or remove the tumor.
SurgerySurgery is usually the first approach. Because meningiomas tend to have well-defined edges and do not invade the brain, complete removal is sometimes possible. The standard treatment is to remove the tumor, the portion of the lining of the brain or spinal cord where it is attached and any bone involved.
However, many tumors are at the base of the brain near cranial nerves and blood vessels. Surgery to remove these tumors is more complicated because of the risk of damaging the nerves and blood vessels. Complete surgical removal is sometimes not possible.
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