Meningioma

A meningioma is a brain tumour that develops in the layers of tissue that surround and protect the brain and spinal cord. This tissue 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 an 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.

Understanding meningioma

A meningioma is a tumour that starts in the meninges. The meninges are layers of tissue (membranes) that cover and protect the brain and the spinal cord. There are three layers: 

  • the dura mater
  • the arachnoid
  • the pia mater (see diagram).

Side view of the head showing the meninges

Structure of the brain
Structure of the brain

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Most meningiomas are slow growing. They are sometimes called benign tumours (not cancerous). But your doctor may talk to you about the ‘grade’ of the tumour rather than whether it is benign or malignant. The grade indicates how slowly or quickly the tumour may grow. A small number of meningiomas are faster growing and behave more like a malignant (cancerous) brain tumour.

A slow-growing or benign tumour can still cause problems as it grows by pressing on surrounding tissue. But it is less likely than a faster-growing tumour to grow into other parts of the brain.

Meningiomas make up nearly a quarter (25%) of all primary tumours of the central nervous system (CNS) in adults in the UK. They are more common in women and usually affect people over the age of 35.

It’s best to read this along with our general information about brain tumours, which has more detailed information about tests and treatments. If you need information about meningioma in children, you can contact the Children’s Cancer and Leukaemia Group.


Causes of meningioma

We don’t know what causes meningiomas, but research is going on to find out more. Having had previous radiation to the head or a genetic (hereditary) condition called type II neurofibromatosis may be risk factors.


Symptoms of meningioma

Meningiomas usually grow slowly. They may not cause obvious symptoms and are sometimes found during tests for other conditions.

Meningiomas often develop on the surface of the brain in a part called the cerebrum (see diagram). Some symptoms depend on the part of the brain that’s 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
  • being confused.


Tests for meningioma

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. 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. 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. It can be done using a CT scan or an MRI scan.

Or you can have an injection of dye through a thin, flexible tube (catheter) inserted into an artery in your groin, arm or neck. After this you have a series of x-rays taken. 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 may be done under a general or a local 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 how the tumour cells look when they are examined under a microscope by a doctor (pathologist). The grade of the tumour gives an idea of how slowly or quickly it may grow.

Meningiomas can be graded as follows:

  • Grade 1 (low grade) is the most common type. These tumours are slow-growing and don’t usually come back after treatment as long as all the tumour is removed.
  • Grade 2 (sometimes called atypical) grows more quickly than grade 1 meningioma and may be more likely to come back after treatment.
  • Grade 3 (malignant) is likely to grow more quickly and has a higher chance of coming back after treatment.


Treatment for meningioma

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 your 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 (watch and wait)

If a meningioma is small and not causing symptoms, you may not need treatment straight away. Most meningiomas are very slow growing so you can delay treatment until it is needed. In some people the tumour grows so slowly that treatment is never 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 assess you and check for any new symptoms.

Surgery

Where possible, surgery is the main treatment for meningioma. In many cases, surgery is the only treatment needed. But 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. 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.

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.

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 low-grade meningiomas that cannot be completely removed
  • after surgery for high-grade meningiomas to reduce the chance of it 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 treatment to be given precisely to the tumour and very low doses to nearby areas of the brain. Stereotactic radiotherapy can be given as individual sessions over a number of weeks. Another technique called stereotactic radiosurgery (or gamma knife, cyber knife, or linac based 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 radiotherapy.

Radiotherapy makes you feel very tired and this can carry on for weeks or longer after it finishes. Get plenty of rest, but try to balance this with some gentle activity such as short walks. This can help you to feel less tired.

The skin in the treated areas may become itchy and red or darker. You will lose the hair in the area being treated. This usually grows back again after 2 to 3 months. We have more information about coping with hair loss.

Your cancer doctor and specialist nurse will talk to you about the side effects of radiotherapy and how they are managed. They will also explain the risk of late side effects. These are side effects that sometimes start months or years after radiotherapy.

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. We have more information about steroids.


Driving

You may not be allowed to drive for a period of time. Although this can be upsetting, it’s important to follow the advice you are given.

You will need to contact the Drivers and Vehicle Licensing Association (DVLA) if you live in England, Scotland or Wales. If you live in Northern Ireland you will need to contact the Driver and Vehicle Agency (DVA). They will advise you of any restrictions on your right to drive:

  • The Drivers and Vehicle Licensing Agency (DVLA) has information about driving with a medical condition if you live in England, Scotland or Wales. Visit GOV.UK or call 0300 790 6806.
  • The Driver and Vehicle Agency (DVA) has information about driving with a medical condition if you live in Northern Ireland. Visit nidirect or call 0845 4024 000.

If you’re not sure what you should do, check with your cancer doctor or specialist nurse. They will explain things to you.


Follow-up

After your treatment has finished, you’ll have regular check-ups, tests and scans. These appointments are a good opportunity to talk to your doctor about any worries or problems you have.

Many people find they get very anxious before appointments. This is natural. It can help to get support from family, friends, your specialist nurse or one of the organisations listed on our database. You can also talk things over with one of our cancer support specialists on 0808 808 00 00.