Almost a quarter of all brain tumours in adults are meningiomas. They are most common in older people and in women; they are very rare in children. The majority of meningiomas are low grade and slow growing, however, some do not behave as expected and can be more aggressive.
A meningioma is a type of brain tumour that develops in the meninges. The meninges are a set of three membranes that cover and protect the brain and spinal cord. They are called the dura mater, the arachnoid mater, and the pia mater.
Brain tumours are graded from 1 - 4, according to what they look like under the microscope as well as their behaviour, such as the speed at which they are growing.
Meningiomas can be graded 1,2 or 3.
Grade 1 Meningioma – the most common type, slow growing and less likely to return after treatment.
Grade 2 Meningioma – slow growing but may be more likely to recur after treatment.
Grade 3 Meningioma – very rare type, faster growing and has a higher chance of returning after treatment.
Symptoms of meningiomas typically begin gradually. As they often grow slowly the brain can become accustomed to their presence as they gently push and compress rather than invade brain tissue. Symptoms may not be obvious and meningiomas are sometimes found in tests for other conditions. As with other brain tumours, the symptoms of meningiomas will depend on which part of the brain is being affected. Some common symptoms can be:
When you are diagnosed with a meningioma the most appropriate treatment for you can depend on a number of factors. Things that your medical team will consider when deciding what treatment is right for you can include:
Due to all of these considerations, treatment can vary from patient to patient.
Watch and wait
Some meningiomas may not need immediate treatment. This is usually when they are small, slow growing and not causing symptoms. You will see your specialist for regular check ups/MRI scans every 3, 6 or 12 months. This approach is sometimes called “watch and wait".
Surgery is the main treatment for meningiomas and in many cases meningiomas can be fully removed by surgery with no requirement for further treatment. Patients will still have regular scans for a period of time to ensure that there is no recurrence.
Radiotherapy may be used on its own when surgery is not possible, or following surgery where the tumour is unable to be completely removed, or to reduce the chance of the tumour returning.
Sometimes a type of radiotherapy called stereotactic radiotherapy (SRT) is used. This treatment uses X-ray beams to more accurately target the tumour from different angles. The beams intersect at the tumour site, maximising the dose of radiation there and destroying tumour cells. SRT can be given over multiple sessions (fractionated stereotactic radiotherapy or FSRT), or it can be given in one session (stereotactic radiosurgery or SRS). SRS does not involve actual surgery. Not all brain tumours are suitable to be treated with SRT or SRS - conventional radiotherapy is more appropriate in some cases.
Chemotherapy is rarely used in the treatment of meningiomas. The blood-brain-barrier (BBB) is a membrane of cells which helps to protect the brain from harmful substances in the blood, such as bacteria or viruses, that could cause infections. This membrane is one of the reasons why it is difficult to develop chemotherapy drugs which can reach the brain. Meningiomas occur outside of the BBB, therefore some drugs can reach them. However, meningiomas are very resistant to currently available chemotherapies. Chemotherapy may still be used in some circumstances, such as a high grade meningioma recurring after surgery or radiotherapy.
As with most brain tumours, the cause of meingiomas is not known. Exposure to radiation is the only known environmental risk. A small number of brain tumours are caused by rare genetic conditions - the rare condition neurofibromatosis type 2 is known to increase the risk of meningioma and other brain tumours.
Some meningiomas have specialised cells (receptors) that interact with hormones, including progesterone, androgen, and oestrogen. It has been observed that occasionally meningiomas can grow faster during pregnancy. Research is looking at the role of hormones in the growth of meningiomas to understand the significance of this.
Prognosis in relation to brain tumours refers to the likely course and expected outcome of the condition. It is important to remember that everyone's journey is unique and not necessarily represented by an average, which does not take into account individual circumstances such as general health and the quality of care provided by their hospital or treatment centre.
Information about prognosis can be difficult to receive - some people do not want to know, whilst others do. There is no wrong or right answer as to whether, or when, to receive such information. If you would like information about prognosis, please see our Prognosis page.
Page last reviewed: 08/2016
Next review date: 08/2019
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