A meningioma is a tumor of the protective linings of the brain and spinal cord. These linings are called meninges. Most meningiomas are benign, though some may be cancerous. Benign meningiomas are generally slow growing. They usually don't cause problems unless they are pushing on the brainstem and/or compressing structures such as optic and cranial nerves.
Malignant (cancerous) meningiomas are faster growing, often cause neurological problems, and can cause swelling in the brain.
Symptoms may include headaches, problems with vision, changes in behavior, vomiting, and pain.
Several minimally invasive treatments are available at UPMC, offering benefits such as minimal scarring, fewer side effects and complications, and faster recovery. These include the Endoscopic Endonasal Approach (EEA) to reach meningiomas at the base of the skull, and NeuroendoportSM Surgery to reach meningiomas within the fluid spaces of the brain (the ventricles). If complementary treatments such as radiation therapy and chemotherapy are needed, those therapies can begin soon after surgery.
Your doctor will ask about your symptoms and medical history and perform a physical exam. Symptoms of meningioma are usually related to the area of the brain that is affected. Often the symptoms are caused by increased pressure within the skull.
Symptoms may include:
- headaches
- vomiting
- double vision or blurry vision
- changes in behavior
- seizures
- loss of sensation or weakness in the arms and legs
- slurred speech (if tumor is on the left side of the brain)
- loss of coordination and memory loss (if tumor is in the temporal lobe)
- difficulty writing (if tumor is in the parietal lobe)
Your doctor will request imaging and diagnostic procedures such as CT and MRI scans, angiogram, and electroencephalogram (EEG). You will also be given a neurologic test to assess your motor skills.
Often both benign and malignant meningiomas require some form of treatment. These could include surgery and/or radiation therapy depending upon the location of the tumor and symptoms.
Surgery
Malignant meningiomas are surgically removed whenever possible, while benign meningiomas are removed if they are large and/or causing neurologic problems. The type of procedure depends on the size and location of the tumor. Several minimally invasive surgical options allow UPMC surgeons to access areas that previously were difficult or impossible to reach. If complementary treatments such as radiation therapy and chemotherapy are needed, those therapies can begin soon after minimally invasive surgery.
The Endoscopic Endonasal Approach (EEA) is an innovative approach to surgery that takes advantage of the nose and nasal cavities as natural pathways to the tumor. EEA is appropriate for tumors at the base of the skull or upper spine.
Tumors located in the following areas can be treated with EEA:
- transribriform: olfactory groove meningiomas
- transplanum: planum sphenoidale meningiomas and tuberculum sellae meningiomas
- transsellar: sellar meningiomas
- transclival: petroclival meningiomas and foramen magnum
- transodontoid: foramen magnum meningiomas, anterior upper spine
- transpterygoid: infratemporal fossa meningiomas
- transorbital: intraconal meningiomas (located inside the orbit) or extraconal meningiomas (pushing on the periorbit)
NeuroendoportSM Surgery offers a minimally invasive option for meningiomas located within the ventricles (fluid spaces). A narrow tube or port allows doctors to access the tumor through a tiny incision in the skull, in contrast to conventional brain surgery.
At UPMC, we take a 360° Approach to treatment when evaluating each patient—looking at their conditions from every direction—to find the path that is least disruptive to the patient's brain, critical nerves, and ability to return to normal functioning. Our neurosurgical team may recommend a combination of surgical and non-surgical approaches to maximize the benefits of surgery while minimizing risks.
Radiation
Radiation therapy is commonly used after surgery has been performed. If the tumor is causing problems but cannot be surgically removed, radiation therapy alone can be an effective way of treating the tumor and stopping its growth. If the tumor is confirmed to be malignant, radiation is generally offered. Radiation is given to help prevent the tumor from coming back.
Patients may receive 25 to 40 daily treatments of traditional radiation therapy or a single treatment of stereotactic radiosurgery, such as Gamma Knife or CyberKnife.
Chemotherapy
Chemotherapy is used only in the treatment of malignant meningiomas. Several medications are available and are generally used in conjunction with surgery and radiation therapy.
