A meningioma is a type of brain tumour that starts in the the brain or, occasionally, in the spinal cord. This section describes the causes, symptoms and treatments.
This information should be read with our section on brain tumours, which has more detailed information about tests, treatments and their side effects. We also have a factsheet on spinal cord tumours.
The brain and spinal cord make up the central nervous system (CNS). The brain controls different functions of the body, including how we think, feel, learn and move. The spinal cord is made up of nerves that run down the middle of the back (spine). Messages between the brain and other parts of the body travel through the spinal cord.
A tumour can be benign (not cancerous) or malignant (cancerous). A benign brain tumour can cause problems as it grows by pressing on surrounding tissue, but it can’t spread to other parts of the brain. A malignant tumour can cause problems by growing into nearby tissues and may spread to other parts of the brain.
Most meningiomas are benign, although some are malignant.
A meningioma is a tumour that starts in the meninges. The meninges (see diagram) are layers of tissue (membranes) that cover and protect the brain and the spinal cord. There are three layers: the dura mater; the arachnoid; and the pia mater.
Each year, about 9000 people in the UK are diagnosed with tumours of the central nervous system (CNS). Meningiomas make up nearly a quarter (25%) of these. They are most common in middle-aged or older people.
Causes of a meningioma
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As with most CNS tumours, it’s not known what causes meningiomas, but research is going on to find out more. Previous radiation to the head or a genetic (hereditary) condition called type II neurofibromatosis may be risk factors.
Meningiomas usually grow slowly. They may not cause obvious symptoms and are sometimes found during tests for other conditions.
Meningiomas often develop in the part of the brain called the cerebrum (see diagram above). Some of the symptoms will depend on which part of the brain is affected by the tumour.
Possible symptoms are:
changes in personality, being confused
weakness in an arm or leg
problems with sight.
Occasionally, the main symptoms are due to an increase in pressure in the brain (called raised intracranial pressure). This may be because of swelling around the tumour, or a build-up of the cerebrospinal fluid (CSF) that surrounds and protects the brain and spinal cord. The symptoms of raised intracranial pressure are headaches, sickness (vomiting), problems with sight and balance, and being confused.
Your doctors need to find out as much as possible about the type, position and size of the tumour, so they can plan the best treatment for you. You will have a number of different tests.
The doctor will examine you and do checks on your nervous system. This includes checking your reflexes and the power and feeling in your arms and legs. They also shine a light at the back of your eye to check if the optic nerve is swollen, which can be a sign of raised pressure in the brain. Your doctor will ask some questions to check your reasoning and memory. You will also have blood tests taken to check your general health and to see how well your kidneys and liver are working.
You will have a CT scan or MRI scan 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 only takes a few 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.
Hear from a superintendent radiographer in CT, and Jyoti, a CT scan patient, about what to expect when having a CT scan.
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 is taken.
Meningiomas can usually be diagnosed with scans so a biopsy (removing a small piece of the tumour) is rarely needed.
If you have a biopsy, it will usually be done under a general anaesthetic. The neurosurgeon (brain surgeon) makes a small hole in the skull and passes a fine needle through into the tumour. They remove a small sample of tissue, which is examined to find out the type of cells the tumour is made up of.
Grading is about how the tumour cells look when they are examined under a microscope by a doctor (pathologist). The grade of the tumour grade gives an idea of how quickly the tumour may grow.
Meningiomas can be graded as follows:
Grade 1 (benign) is the most common type. These are slow-growing and don’t usually come back after treatment.
Grade 2 (sometimes called atypical) grows more quickly than grade 1 meningiomas and may be more likely to come back after treatment.
Grade 3 (malignant) is likely to grow more quickly and to have a higher chance of coming back after treatment.
The main treatments for meningioma are surgery and radiotherapy. Some people have the tumour monitored and delay treatment until it is needed.
Your treatment will depend on the size and position of the tumour, your symptoms and general health.
Your specialist doctor and nurse will explain the aims of your treatment and what it involves. They will talk to you about treatment benefits and disadvantages. They will also explain the risks and side effects.
Deciding on the treatments that are right for you is a decision you make in partnership with your doctor. Make sure you have enough information and time to help you make treatment decisions.
If a meningioma is small and not causing symptoms, you may not need treatment straightaway. Most meningiomas are very slow-growing and some people won’t need treatment for a long time. You can delay treatment until it is needed.
You will have regular scans to monitor for any changes in the tumour. You will also have regular appointments with your specialist who will asses you and check for any new symptoms.
Where possible, surgery
is the main treatment for meningioma. In many cases, meningiomas are removed completely without any further treatment. If the surgeon cannot remove the tumour completely, they may suggest you have radiotherapy to get rid of any remaining cells.
Your surgeon will explain what the operation will involve. They will talk to you about the complications and risks.
It can take a while to recover after surgery so it’s important to take good care of yourself. Get plenty of rest, try to eat well and follow the advice given by your surgeon and specialist nurse.
Some people may need extra support to help with their recovery. This may be from a physiotherapist who can help you to improve your balance, walking or strength. Occupational therapists can provide equipment and help you be more independent. Other services such as speech therapy or psychological support are also available.
Sometimes an operation is not possible. This may be because the position of the tumour makes it too difficult to reach and surgery would not be safe. Radiotherapy can be used instead.
Radiotherapy treatment uses high-energy rays to destroy the tumour cells. Your cancer doctor (oncologist) will tell you how long your treatment will last for and the type of radiotherapy you will have.
Radiotherapy may be used:
on its own when surgery is not possible
after surgery for benign meningiomas that cannot be completely removed.
after surgery to reduce the chance of a meningioma coming back.
Sometimes doctors use a type of radiotherapy called stereotactic radiotherapy. Targeted beams of radiotherapy are given from different angles and cross at the point of the tumour. This allows larger doses of to be given precisely to the tumour and very low doses to the surrounding tissues. Stereotactic radiotherapy can be given as individual sessions over a number of weeks. Another technique called radiosurgery (or gamma knife treatment) can also be used. It doesn’t involve any surgery. You have it in one session over a few hours. You may have radiosurgery if you have a small tumour.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is rarely used to treat meningiomas.
Treatments to control symptoms
Steroids help to reduce the swelling around a tumour. You may be given them after surgery or radiotherapy. Some of the side effects include indigestion, weight gain, restlessness, agitation and sleep disturbance. Let your doctor or nurse know if these are causing problems or you notice any other effects. Taking steroids with food can help reduce indigestion.
If you have seizures (fits), you will be given drugs called anticonvulsants to help prevent them.
It’s very important to take these drugs exactly as your specialist doctor has prescribed them.
Being diagnosed with a brain tumour may feel very frightening at times. You may have many different feelings, including anxiety, anger, fear, feeling low or depressed. Many people go through these in coping with their illness.
It’s important to get the support you need. You may find it helpful to talk things over with family and close friends and with your doctor or nurse. You can also talk to one of our support service nurses. Sometimes people need more help to cope with difficult feelings of anxiety or depression. Your doctor can refer you to a counsellor or psychologist for more support.
You may not be allowed to drive for a period of time, depending on the treatment you have had and if you have had any seizures (fits). Although this can be upsetting, it’s important to follow the advice you are given. Your doctor will ask you to contact the Driver & Vehicle Licensing Agency (DVLA). It is your responsibility to contact the DVLA. Your doctor or nurse will explain what you need to do.
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.
The Brain Tumour Charity
The Brain Tumour Charity provides personalised support, available online, on the phone, by email and through support groups.
This section has been compiled using information from a number of reliable sources, including:
Packer R, Schiff D (Eds). Neuro-oncology. 2012. Wiley-Blackwell.
Kaye A, Laws E. Brain Tumors (3rd edition). 2011. Saunders Elsevier.
Meningioma. 2013. BMJ Best Practice. (accessed March 2014)
Thanks to Mr Andrew Brodbelt, Consultant Neurosurgeon who reviewed this edition.
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