A meningioma is a specific type of tumour that affects the brain or spinal cord. This information describes the causes, symptoms and treatments of meningiomas, and should ideally be read with our general information about brain or spinal cord tumours.
The central nervous system (CNS) is made up of the brain and spinal cord. Cells in the CNS normally grow in an orderly and controlled way. If for some reason this order is disrupted, the cells continue to divide and form a lump or tumour.
A tumour is either benign or malignant. Benign tumours can continue to grow but the cells do not spread from the original site. In a malignant tumour, the cells can invade and destroy surrounding tissue and may spread to other parts of the brain.
A meningioma is a tumour of the meninges, which are the protective membranes around the brain and spinal cord.
A meningioma can start in any part of the brain or spinal cord, but the most common sites are the cerebral hemispheres of the brain, made up of the four lobes shown on the diagram below:
Most meningiomas are benign and malignant ones are rare.
Each year about 4,700 people in the UK are diagnosed with tumours of the central nervous system (CNS). Meningiomas make up nearly a quarter (25%) of all primary brain tumours. They are most likely to be found in middle-aged or elderly people. Meningiomas are more common in women than in men.
Causes of a meningioma
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A meningioma can sometimes be found in people with type II neurofibromatosis, which is a neurological illness. Research is being carried out into other possible causes.
Meningiomas are usually slow-growing tumours, and the main symptoms arise from increased pressure within the skull (raised intracranial pressure). This may be due to a blockage in the ventricles (fluid-filled spaces of the brain), which leads to a build-up of cerebrospinal fluid (CSF). CSF is the fluid that surrounds and protects the brain and spinal cord. The increased pressure may also be caused by swelling around the tumour itself.
Raised intracranial pressure can cause headaches, sickness (vomiting) and problems with your vision. Changes in behaviour and personality are general signs of a brain tumour. Fits (seizures) can be an early symptom.
Meningiomas can grow in different parts of the brain and symptoms will relate to the area of the brain that is affected:
A tumour in the frontal lobe of the brain may cause gradual changes in mood and personality. There may also be paralysis (inability to move) on one side of the body. This is called hemiparesis.
If the left side of the brain is affected there may be problems with speech, such as slurring or muddling of words.
A tumour in the temporal lobe of the brain may cause problems with coordination and memory loss.
If the parietal lobe of the brain is affected, writing and other such activities may be difficult. Hemiparesis may also be present.
Sometimes meningiomas cause little or no symptoms and are discovered during investigations into other conditions.
Tests and investigations for meningiomas
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Your doctors need to find out as much as possible about the type, position and size of the tumour, so they can plan your treatment. You may have a number of tests and investigations.
The doctor will examine you thoroughly and test the power and feeling in your arms and legs, and your reflexes.
Your doctor will look into the back of your eyes using an ophthalmoscope. They can see if the optic nerve at the back of the eye is swollen. This can be caused by oedema (swelling of the tissues within the brain), which may occur due to an increase in the amount of fluid in the brain.
A CT scan or MRI scan will be done to find out the exact position and size of the tumour.
CT (computerised tomography) scan
A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes 10-30 minutes. CT scans use small amounts of radiation, which will be very unlikely to harm you or anyone you come into contact with.
You will be given an injection of a dye, which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.
MRI (magnetic resonance imaging) scan
This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure it’s safe for you to have an MRI scan.
Before having the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan show up more clearly. During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones.
This test involves an injection of a dye to show up the blood vessels in the brain that supply the tumour. The dye is injected through a thin, flexible tube (catheter) that is inserted into an artery in the groin, arm or neck. A series of x-rays are taken. Your nurse or doctor will explain this test to you in more detail.
To give an exact diagnosis, a sample of cells (biopsy) may be taken from the tumour and examined under a microscope. Your doctor will discuss with you whether this is necessary in your case, and what the operation involves. Meningiomas can usually be clearly shown by scans, so a biopsy is rarely necessary.
Grading refers to the appearance of the tumour under a microscope. The grade gives an idea of how quickly the tumour may grow.
There are three grades:
These tumours are the most common type and are slow-growing and benign. Most do not come back after treatment.
These tumours grow more quickly and have a higher chance of coming back after treatment.
These tumours are more likely to grow quickly and spread into the brain. It is common for the tumour to come back after the first treatment. This is known as a recurrence.
Treatment of meningiomas
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The treatment for meningioma depends on a number of things including your general health, and the size and position of the tumour. The results of your tests will enable your doctor to decide on the best type of treatment for you.
Your treatment will usually be planned by a team of specialists known as a multidisciplinary team (MDT). The team will usually include a:
doctor who operates on the brain (neurosurgeon)
doctor who specialises in treating illnesses of the brain (neurologist)
doctor who specialises in treating brain tumours (an oncologist)
specialist nurse and possibly other healthcare professionals, such as a physiotherapist or dietitian.
There are some risks associated with treatment to the brain, and your doctor will discuss these with you.
If the pressure in the skull is raised, it’s important to reduce it before any treatment is given for brain tumours. Steroid drugs may be used to reduce swelling around the tumour. If the raised pressure is because of a build-up of CSF, a tube (shunt) may be inserted to drain off the excess fluid.
Before you have any treatment, your doctor will give you full information about the aims of the treatment and what it involves. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment.
No medical treatment can be given without your consent.
Benefits and disadvantages of treatment
Treatment can be given for different reasons and the potential benefits will vary for each person. If you have been offered treatment that aims to cure your tumour, deciding whether to have the treatment may not be difficult. However, if a cure is not possible and the treatment is to control the tumour for a period of time, it may be more difficult to decide whether to go ahead.
If you feel that you can’t make a decision about the treatment when it’s first explained to you, you can always ask for more time to decide.
You are free to choose not to have the treatment and the staff can explain what may happen if you do not have it. Although you don’t have to give a reason for not wanting to have treatment, it can be helpful to let the staff know your concerns so that they can give you the best advice.
If the tumour is small, immediate treatment may not be needed. This is because most meningiomas tend to be slow-growing, and it may be a long time before any symptoms require treatment. In this situation, regular scans will be done to check for any growth of the tumour. This is called active surveillance.
Where possible, surgery is the main treatment for meningioma and in many cases the tumour can be removed completely with no complications.
Occasionally, the position of a tumour makes it impossible or too risky to remove surgically. If surgery is not possible, your doctor will discuss other types of treatment with you.
Radiotherapy treatment uses high energy rays to destroy the cancer cells. It may be used after surgery for malignant meningioma to reduce the chance of the tumour coming back. It may be used after surgery for benign meningiomas that cannot be completely removed.
If surgery is not possible, radiotherapy may be used alone. Sometimes a technique known as stereotactic radio-surgery may be used, in which hundreds of beams of radiotherapy are aimed at the tumour in a single session. This is a very accurate treatment allowing larger doses of radiotherapy to be given with less damage to surrounding tissues. It is used mainly for smaller tumours and for tumours that have come back.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy is very rarely used for treating meningioma although research continues into developing this form of treatment.
Medicines for seizures
If you experience seizures you may be given a medicine called an anticonvulsant to help prevent them.
Research into meningiomas
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Recent research has shown a possible link between meningioma and hormone levels. Trials using hormonal drugs to treat this type of tumour are in the early stages.
You may find the idea of a tumour affecting the brain extremely frightening. You may experience many emotions including anxiety, anger and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with their condition.
Many people find it helpful to talk things over with their doctor or nurse, or one of our support service nurses. Family members and close friends can also offer support.
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In some circumstances you may not be allowed to drive for a period of time. If you have had an epileptic fit, the Drivers and Vehicle Licensing Association (DVLA) will not allow you to drive for a year after your last fit. You can then drive again provided you remain well.
If you have a benign menigioma and have not had any seizures, the DVLA requires that you do not drive for at least six months after surgery. Initially, your licence may only be for a short period.
You may not be allowed to drive some types of vehicle, such as an LGV (large goods vehicle) or a PCV (passenger carrying vehicle), for at least five years after surgery. If you’ve had any seizures, you will not be able to drive these types of vehicle until 10 years after your last fit. In some circumstances, it will be recommended that you never drive these vehicles. You may require a medical assessment before your driving licence is renewed.
The hospital will not contact the DVLA. It’s your responsibility to do so and your doctor will advise you how to do this.
Drivers and Vehicle Licensing Association (DVLA)
The DVLA advises GPs and other members of the medical profession on the medical standards of fitness to drive. Patients should seek advice from their doctors.
This information has been compiled using information from a number of reliable sources, including:
De Vita, et al. Cancer: Principles & Practice of Oncology. 8th edition. 2008. Lippincott Williams and Wilkins.
National Institute for Health and Clinical Excellence (NICE). Improving Outcomes for People with Brain and Other CNS Tumours-The Manual. 2006.
Raghavan, et al. The Textbook of Uncommon Cancers. 3rd edition. 2006. Wiley.
Souhami, et al. Oxford Textbook of Oncology. 2nd edition. 2002. Oxford University Press.
Thanks to Dr Catherine McBain, Consultant Clinical Oncologist,, and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.