Meningioma

A meningioma is a brain tumour that develops in the layers of tissue that surround and protect the brain and spinal cord. This is called the meninges. Meningiomas are usually benign and grow very slowly although some can be faster growing.

Symptoms may include:

  • headaches
  • sickness (vomiting)
  • weakness in an arm or leg
  • personality changes, being confused
  • seizures (fits).

To find out more about the tumour you will need different tests such as a MRI scan, a CT scan, a biopsy or an angiogram.

Your specialist will talk to you about the best treatment for you and explain the benefits and disadvantages.

Surgery and radiotherapy are usually the main treatments and some people have both.

Your doctor may prescribe steroids to help control the symptoms if needed. If the tumour is small and not causing symptoms, you may have monitoring and delay treatment until you need it.

Treatments can cause side effects. You doctors will explain what to expect and how side effects can be managed.

About brain tumours

A meningioma is a type of brain tumour that starts in the brain or, occasionally, in the spinal cord.

This information describes the causes, symptoms and treatments. It should be read with our general information brain tumours, which has more details about tests, treatments and their side effects. We also have a section 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.

Side view of the head showing the meninges
Side view of the head showing the meninges

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Understanding meningiomas

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

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.


Symptoms

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). Some of the symptoms will depend on which part of the brain is affected by the tumour.

Possible symptoms are: 

  • headaches
  • changes in personality, being confused
  • weakness in an arm or leg
  • seizures (fits)
  • 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.


Tests

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 scan

A CT (computerised tomography) scan uses x-rays to build a three-dimensional picture of the inside of the body. You may be given either a drink or injection of dye. This is to make certain areas of the body show up more clearly. This scan takes around 30 minutes and is painless. We have more detailed information about having a CT scan.


MRI scan

This scan uses magnetism to build up a detailed picture of areas of your body. You may be given an injection of dye, into a vein, to improve the images from the scan. This test is painless and will take around 30 minutes. We have more detailed information about having an MRI scan.


Angiogram

This test uses an injection of a dye and x-rays to see 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. Angiograms can be done as part of a CT or MRI scan.

Your nurse or doctor will explain this test in more detail.


Biopsy

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

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.


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.


Monitoring (observation)

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.


Surgery

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

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.

We have more detailed information about stereotactic surgery.


Chemotherapy

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.


Driving

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.


Back to Types of brain tumour

Acoustic neuromas

An acoustic neuroma is a of brain tumour of the hearing nerve. It is sometimes called a vestibular schwannoma.

Astrocytomas

Astrocytomas, also known as astrocytic tumours, are a type of brain tumour.

CNS lymphoma

Most lymphomas start in lymphatic organs. But CNS lymphoma starts in the central nervous system.

Ependymoma

An ependymoma is a rare type of brain tumour.

Haemangioblastoma

A haemangioblastoma is a rare brain tumour that starts in the cells that line blood vessels in the brain.

Medulloblastoma

A medulloblastoma is a rare form of brain tumour.

Mixed gliomas

Mixed gliomas are a type of brain tumour that contains different types of glial cells.

Oligodendroglioma

An oligodendroglioma is a type of brain tumour that starts in the cells that cover nerve cells.

Pineal region tumours

Pineal-region tumours develop in the area of the pineal gland in the brain. They can be benign or malignant.

Pituitary tumours

Pituitary tumours start in the pituitary gland, which is at the base of the brain. They are usually benign.