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Treating meningiomas

Your medical team will consider a range of factors about your meningioma when deciding the most appropriate treatment.

Meningiomas are normally treated according to their grade, but their size, location and the symptoms you're experiencing will also affect the treatment you're offered. 

However, treatment for more than 1 meningioma may be different, as the tumours may be of different grades and have different growth rates. If this is the case, some treatments, such as active monitoring may not be suitable.

Surgeons prefer not to perform repeat surgery, as any surgery carries some risk, but if your tumour comes back or you have more than 1 tumour, surgery may be considered depending on your general health and the growth rate of your tumours

With multiple meningiomas, there’s also the possibility of stereotactic radiosurgery. 

It's important to note that your healthcare team should discuss these options with you and you should feel comfortable asking any questions you may have.

Grade 1 meningiomas

Active monitoring

Active monitoring (also known as watch and wait) is frequently the treatment approach used for grade 1 meningiomas.

If you're on active monitoring, you'll see your specialist for regular check-ups and MRI scans. This will usually be every 3, 6 or 12 months.

You may only begin treatment if:

  • there's a marked increase in tumour size
  • you develop symptoms (or they become much worse) that badly affect your quality of life, for example, uncontrollable seizures. 
  • the tumour starts growing more quickly and becomes a higher grade.

Why is active monitoring used? 

If your tumour is low grade, only growing very slowly and it’s causing no, few or controllable symptoms that you feel you can live with, active monitoring it has the advantage that you don’t need to have brain surgery with all its risks and side-effects. 

You may find not having any treatment difficult at first and you may feel particularly anxious about your scans, but people usually find it gets easier with time.

Your healthcare team or our Information and Support Line can give advice on coping. You may find it helpful to talk to others in a similar situation by joining one of our closed Facebook Groups.

Surgery

Neurosurgery may be offered after a period of active monitoring or it can be offered straight away after diagnosis. It’s generally offered if the tumour is causing, or likely to cause, problems or symptoms that affect your day-to-day living. This will partly depend on its size and location within the brain.

It may be the only treatment needed, especially if all of your tumour can be removed.

Radiotherapy

Radiotherapy may be used in the following circumstances:

  • if all of your tumour can’t be removed, then radiotherapy may be used after surgery
  • if the tumour is in part of the brain which means it’s not possible to operate on (known as a non-operable tumour)
  • if your tumour has come back (also known as a recurrent tumour).

If your tumour can’t be operated on, a type of radiotherapy called stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) may be used instead of conventional radiotherapy.

SRS and SRT allow high doses of radiation to be given to a very focussed, precise area. It’s only suitable for small tumours (less than 3cm at the widest part) but it can be used instead of surgery to avoid risking damage to crucial parts of the brain. 

Grade 2 or 3 meningiomas

The treatment for grade 2 and 3 meningiomas is usually surgery (where possible), followed by radiotherapy.

Chemotherapy

Chemotherapy is rarely used in the treatment of meningiomas, as they are very resistant to currently available chemotherapies. It may still be used in some circumstances, such as a high grade meningioma (grade 3) recurring after surgery or radiotherapy.

Getting a second opinion

If you’re uncertain about the decision to put you on active monitoring (or any other decision about your care and treatment), even after talking to your healthcare team, you can ask for a second or further opinion, either on the NHS or privately.

Under the NHS Constitution, you have a right to ask your GP or another healthcare professional for a second or further opinion from a different doctor. That does not mean you have a legal right to get one, but a healthcare professional will rarely refuse. Healthcare professionals are used to being asked about second opinions, so they won’t be offended by the request, nor will your care be affected. 

The Patient Advice and Liaison Service (PALS) in your hospital or your local citizens’ advice service (CAB) may be able to offer advice if you're having difficulty getting referred for a second opinion. You could also contact our Information and Support team.

Get support

If you need someone to talk to or advice on where to get help, our Support and Information team is available by phone, email or live-chat.

If you have further questions, need to clarify any of the information on this page, or want to find out more about research and clinical trials, please contact our team:

Support and Information Services

0808 800 0004 (free from landlines and mobiles)

support@thebraintumourcharity.org

Phone lines open Mon-Fri, 09:00-17:00

You can also join our active online community on Facebook - find out more about our groups.