Definition

Meningioma refers to a tumor that develops on the meninges, the protective membranes covering the brain and spinal cord. These tumors typically grow slowly, are mostly benign, and do not require immediate treatment. However, there is a possibility that the tumor may progress to cancer, spreading to other organs in some cases. Meningioma is the most common type of brain tumor.

Meningiomas originate from arachnoid cap cells, which are part of the thin, spider-web-like membrane covering the brain and spinal cord. The arachnoid is one of the three layers of protective membranes surrounding the brain and spinal cord.

Based on malignancy, meningiomas are categorized into three grades of severity:

• Grade 1 or Typical

This is a benign meningioma that grows slowly, accounting for 80% of cases.

• Grade 2 or Atypical

A non-cancerous meningioma that grows faster but remains responsive to treatment if addressed promptly. It appears in 17% of cases.

• Grade 3 or Anaplastic

This type is malignant and grows and spreads rapidly. Anaplastic meningiomas occur in 1.7% of cases.

Causes

The exact cause of meningioma remains unknown. However, some research suggests chromosomal abnormalities may play a role, leading to excessive cell division of arachnoid cells and eventually forming a tumor. Certain risk factors have been shown to influence the development of meningiomas.

Risk factor

Several risk factors may increase the likelihood of developing meningioma, including:

• Female gender
• Age 70–80 years
• Previous history of radiation therapy
• Personal or family history of neurological disorders
• Rare genetic disorders in the family, such as neurofibromatosis type 2 (a genetic condition causing benign tumors along nerve fibers)
• Obesity
• Specific races or ethnicities, such as African ethnicity

Symptoms

Due to their slow growth, meningiomas may not present symptoms for years. Symptoms generally appear when the tumor reaches a substantial size. Potential symptoms include:

• Headaches
• Seizures
• Blurred vision
• Double vision
• Weakness in the arms or legs
• Reduced sensory perception or numbness
• Loss of balance
• Memory loss
• Hearing loss

Diagnosis

Diagnosis involves a thorough medical interview, physical examination, and supporting tests:

Medical interview

The doctor will inquire about the patient's symptoms, medical history, family history, and previous treatments to assess compatibility with meningioma symptoms.

Physical examination

This assesses neurological function, including balance, vision, reflexes, facial nerves, limb nerves, and sensory responses to identify any neurological impairments.

Supporting examination

Imaging tests like Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are used to confirm the tumor’s location, size, and potential danger. Pathological examination of tumor cells may also be conducted to determine the tumor’s type and malignancy, guiding treatment decisions.

Management

Treatment depends on several factors:

• Tumor location
• Tumor type (benign or malignant), size
• Patient’s treatment preferences

Surgery

Open surgery remains the primary treatment, aiming to completely remove the tumor and allow for pathological examination to determine its nature.

Observation

Periodic imaging (MRI, CT) is performed to monitor tumor development over time. Treatment may be initiated if symptoms develop or the tumor size increases.

Surgical procedure

Craniotomy is the common surgical approach, involving a scalp incision and removal of a small portion of the skull to access and carefully remove the tumor.

Radiotherapy

Uses X-rays and other radiation forms to target and potentially shrink the tumor. It is particularly useful for tumors located in areas where surgery is too risky.

Rehabilitation therapy

Post-treatment rehabilitation helps restore normal bodily functions. This may include physical therapy for motor weaknesses or speech therapy for language difficulties.

Complications

Meningioma may lead to various complications, including:

• Difficulty concentrating
• Memory loss
• Personality changes
• Limb weakness
• Difficulty understanding language
• Seizures

Prevention

With the cause of meningioma still unknown, prevention focuses on reducing risk factors:

Maintain a healthy lifestyle

Avoid smoking, excessive alcohol consumption, and junk food. Eat a balanced diet and stay hydrated.

Prevent obesity

Obesity is a risk factor for many diseases. Maintaining an ideal weight reduces the risk of tumors and cancers.

Minimize unnecessary radiation exposure

Unnecessary radiation can inhibit cell division, including in cancer cells.

Manage stress

Excessive stress can adversely affect overall health and contribute to disease development.

When to see a doctor?

While most meningiomas grow slowly and rarely require emergency care, seek medical attention if experiencing:

• Severe headaches
• Nausea and vomiting
• Sudden blurred or double vision
• Limb weakness
• Seizures
• Decreased consciousness

Emergency care will involve comprehensive evaluation to determine if symptoms are due to meningioma or another neurological condition.

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