Meningiomas are tumors from brain/spine membranes, mostly benign but some cancerous.
What are meningiomas?
A meningioma is a tumor that arises from the meninges, which are the membranes that surround and protect the brain and spinal cord. Most meningiomas are benign (noncancerous) and slow growing. However, some can be atypical (Grade 2) or malignant (Grade 3), which means they are more aggressive and are more likely to recur and/or require additional
.treatment beyond surgery.
According to the American Brain Tumor Association, meningiomas account for one-third of all primary brain tumors and occur twice as often in women as in men. At AHN, our patients are cared for by compassionate and experienced providers who understand the intricacies of a meningioma diagnosis.
AHN Neuro-Oncology Center of Excellence
Our experts in the AHN Neuro-Oncology Center of Excellence offer some of the newest, most innovative care for patients with benign and malignant brain tumors. We use the latest tools and procedures to make the diagnosis process as minimally invasive as possible. You can get numerous tests done on the same day and in one location to reduce your wait and travel time. We know this is a difficult and stressful time. Our understanding staff is by your side, guiding you and answering your questions. We also offer robust support services to treat the whole person.
Why choose AHN for your meningioma treatment?
Our highly experienced team of neuro-oncologists (brain cancer specialists) and neurosurgeons (brain surgeons) perform treatments that are only available at the very best hospitals in the country. By choosing AHN for your care, you will find:
- Improved survival rates: We use aggressive treatments while making sure you are feeling as well as you can. Helping you live a longer, more comfortable life is our priority.
- Advanced technology: Sophisticated diagnostic tools and genome analysis, allow us to understand how the tumor will respond to different treatments before we prescribe them. That means you will receive the treatment that is tailored to your specific needs.
- Minimally invasive treatments: Many of our treatment options are outpatient procedures that involve a short recovery time. Instead of spending all your time in a hospital, you can live your life and enjoy your family and friends.
- A collaborative approach: We discuss all our patients in a weekly meeting with our brain cancer experts. You benefit from the combined experience of a team that includes neuro-oncologists, radiation oncologists, neurosurgeons, medical oncologists, and neuroradiologists. Because we are always up to date on your progress, we are able to give you the best possible care.
- Robust support: We invite all patients with brain cancer to join our weekly support group to share feelings, discuss symptoms, and help one another cope. It may help you feel better during treatment and experience an improved state of mind.
- A convenient, after-hours cancer clinic: If you experience side effects from treatment, call your physician’s office first, then visit our After Hours Oncology Clinic, conveniently located at West Penn Hospital. We treat you quickly, without exposing your compromised immune system to the germs you may encounter at a traditional emergency room. Plus, our clinic is more affordable than a visit to the ER. And since our oncology specialists have access to your records, they may even be able to advise you over the phone and save you from making a trip.
- Clinical trials: If you meet the eligibility requirements, you may be able to participate in an experimental clinical trial. You could gain access to a groundbreaking treatment before it is widely available. Learn more about our clinical trial program.
Meningiomas symptoms and signs
Since meningiomas are slow growing, their symptoms and signs can develop gradually and be subtle at first. They often become more noticeable as the tumor grows and puts pressure on adjacent brain tissue or nerves. The specific signs and symptoms of a meningioma depend heavily on its location within the brain or spinal cord as well as its size. The most common symptoms and signs of meningiomas include:
- Headaches: Often persistent, worsening over time, and not relieved by typical pain relievers. They may be worse in the morning.
- Seizures: Can be a first symptom, especially for meningiomas located over the cerebral cortex. Seizures can manifest in various ways, from subtle staring spells to full-body convulsions.
- Nausea and vomiting: Especially if headaches are severe or pressure on the brain is significant.
- Changes in mental status/personality: Mood swings, confusion, memory problems, difficulty concentrating, or uncharacteristic behavior.
- Weakness or numbness in limbs: If the tumor is pressing on the motor or sensory cortex, or on the spinal cord. This can affect one side of the body.
- Vision problems: Blurred or double vision, loss of vision in one or both eyes, or loss of peripheral vision happen if the tumor is near the optic nerve.
- Hearing loss or tinnitus (ringing in the ears): If the tumor is near the auditory nerve or within the cerebellopontine angle.
- Loss of smell (anosmia): If the tumor is located near the olfactory nerves (e.g., olfactory groove meningioma).
- Speech difficulties (aphasia): Problems speaking, understanding speech, or finding the right words, if affecting speech centers in the brain.
- Balance problems or dizziness (vertigo): If the tumor affects the cerebellum or brain stem.
- Difficulty swallowing (dysphagia) or facial weakness/numbness: If the tumor is pressing on cranial nerves that control these functions.
Causes and risk factors
Meningiomas are generally not well understood in terms of their exact causes, but research has identified several contributing factors and risk factors. It's important to note that having a risk factor doesn't mean you will definitely develop a meningioma, and many people with meningiomas have no known risk factors. The risk factors for developing meningiomas include:
- Therapeutic radiation to the head: People who received radiation therapy to the head or neck, especially at a young age, for conditions like ringworm of the scalp, acne, or prior cancers (e.g., leukemia, Hodgkin's lymphoma), have an increased risk. The risk depends on the dose and duration of exposure.
- Female sex: Meningiomas are about twice as common in those assigned female at birth, and they sometimes grow faster during pregnancy.
- Genetic syndromes: While most meningiomas are sporadic (not inherited), certain genetic conditions, like neurofibromatosis type 2, significantly increase the risk.
- Age: The risk of developing a meningioma increases with age. They are most commonly diagnosed in older adults, typically after age 60, and are rare in children.
- Immune system suppression: Individuals with compromised immune systems, such as those with HIV/AIDS or organ transplant recipients on immunosuppressant medications, appear to have a slightly increased risk of developing meningiomas.
- Obesity: Some studies have suggested a possible link between obesity and an increased risk of meningiomas, though the exact mechanism is not fully understood. It might involve chronic inflammation or hormonal factors related to obesity.
Meningiomas screening and diagnosis
There is no routine screening for meningiomas. Meningiomas are typically diagnosed through a combination of evaluating symptoms, physical and neurological examinations, and most definitively, through imaging studies. The process often includes:
- Medical history: Your doctor will ask detailed questions about your symptoms, including when they started, how often they occur, their severity, and any factors that make them better or worse. They will also inquire about your general health, past medical conditions, medications, and any relevant family history (e.g., neurofibromatosis).
- Neurological exam: This is a crucial step. The doctor will assess various aspects of your nervous system, including your vision, hearing, balance and coordination, cognition, and more.
- Imaging studies: If a meningioma is suspected based on symptoms and the neurological exam, imaging tests, such as an MRI, CT scan, and angiography may be the next step.
Types and stages of meningiomas
Meningioma types are grouped by their World Health Organization grade, which is also how they are classified for patient risk. The different types of meningiomas include:
- WHO Grade 1: These are the most common types and account for around 80% of meningiomas. They are benign (noncancerous), slow-growing, and often do not return if they have been removed. The different types include:
- Meningothelial
- Fibrous (Fibroblastic)
- Transitional (Mixed)
- Psammomatous
- Angiomatous
- Microcystic
- Secretory
- Lymphoplasmacyte-rich
- Metaplastic
- WHO Grade 2 (Atypical): These meningiomas account for around 15 – 20% of cases and are slightly more aggressive. These tumors (Grade 2 meningiomas) grow and divide faster than Grade 1 tumors, which means they are more likely to come back after treatment and act more aggressively. Doctors can identify them by looking for certain specific features when examining the tissue under a microscope. They can include:
- Atypical meningioma
- Clear cell meningioma
- Chordoid meningioma
- WHO Grade 3 (Malignant/Anaplastic): While rare, only accounting for 1 – 3% of cases, these meningiomas are aggressive and fast-growing They have a high risk of returning and often spread to other areas of the body. The different types include:
- Anaplastic (malignant) meningioma
- Rhabdoid meningioma
- Papillary meningioma
Meningiomas treatment
At AHN, your meningioma treatment will be tailored to your specific needs and incorporate advanced technology designed to remove or reduce the presence of meningiomas. Your dedicated care team works in a multidisciplinary approach so all aspects of your health are considered.
Surgery
Surgical removal is the primary treatment for many meningiomas. The goal is to remove as much of the tumor as possible while preserving neurological function. Treatment approaches include:
- State-of-the-art brain surgery: Our neurosurgeons have subspecialized in performing complex surgeries to remove benign and malignant tumors from the brain and spine. Utilizing minimally invasive techniques, our surgeons are able to remove tumors that were once thought to be inoperable. The use of awake craniotomies to preserve critical language function and physiologic motor mapping are just some of the techniques that we leverage to maximize tumor resection while improving symptoms.
- GammaTile brachytherapy: For recurrent meningiomas that have not responded to prior surgery and radiation therapy, our surgeons are the first treatment center in Pittsburgh to offer GammaTile brachytherapy for recurrent meningiomas.
- Laser interstitial thermal therapy (LITT): This is a minimally invasive surgical procedure that treats certain deep seated brain tumors with laser therapy. Through an incision about the width of your pinky, patients with otherwise inoperable tumors can sometimes be treated and go home the day after surgery with LITT.
Radiation Therapy
Radiation therapy is used to treat meningiomas that are growing but small or for those tumors that cannot be completely removed surgically. Radiation therapy is a treatment option for recurrent meningiomas or for higher grade meningiomas following surgery. Techniques include:
- Gamma Knife®* Radiosurgery: We have one of the busiest radiosurgical programs in the country, treating over 300 patients a year with minimally invasive radiation therapy for benign and cancerous brain tumors including Gamma Knife® Radiosurgery.
- External Beam Radiation Therapy (EBRT): Delivers radiation from outside the body.
Meningiomas FAQs
Questions about a diagnosis are completely normal and expected. Your dedicated AHN care team is here to help you find the answers and solutions to your health needs. To help give you background information on meningiomas, we’ve included frequently asked questions and answers, so that you can start to get the necessary information that will allow you to feel more confident in your care.
Can meningiomas be cancerous?
While the vast majority of meningiomas are benign (noncancerous), a small percentage can be malignant (cancerous). These are categorized as anaplastic (Grade 3) meningiomas, and they tend to grow more aggressively and have a higher chance of recurrence after treatment.
Can you die from a benign meningioma?
Though rare, it is possible to die from a benign meningioma. Even benign tumors can cause serious complications if they grow large enough to compress critical brain structures, nerves, or blood vessels. The severity of symptoms and potential for life-threatening complications depend on the tumor's size, location, and the presence of any associated swelling in the brain.
What is the survival rate for meningiomas?
The survival rate for meningiomas is generally very good, especially for the most common type (WHO Grade 1, or benign meningiomas). However, it varies significantly based on the tumor's grade (aggressiveness) and the patient's age. Overall, the five-year survival rate for all grades of meningiomas is around 65 – 70%. For WHO Grade I (Benign) meningiomas, the five-year survival rate is over 90%, and often close to 100% for younger patients. Most patients with grade 1 meningiomas do not die from their tumor or from the treatments they receive, but fatalities can occur due to other medical conditions independent from their meningioma. Most patients with grade 1 meningiomas do not die from their tumor or from the treatments they receive, but fatalities can occur due to other medical conditions independent from their meningioma.
For WHO grade 2 (atypical) meningiomas, the five-year survival rate is around 70 – 80%. The five-year survival rate for the WHO grade 3 is considerably lower, typically around 50 – 60%.
It's crucial to understand that these are general statistics. An individual's prognosis depends on many factors, including the tumor's size, location, extent of surgical removal, and response to any additional treatments.
What is the life expectancy of a person with a benign meningioma?
For a person with a benign (WHO grade 1) meningioma, especially if it is successfully and completely removed, their life expectancy is often comparable to that of the general population of the same age and health status. Many benign meningiomas are slow-growing and can be managed effectively, either through observation (if small and asymptomatic) or successful surgical removal. The most significant factors that might affect life expectancy are often unrelated to the meningioma itself (e.g., other co-existing health conditions) or complications from treatment, rather than the tumor itself. Regular follow-up is important to monitor for any recurrence, though the risk is low after complete removal.
What is the main cause of meningioma?
The main cause of meningioma is not definitively known for most cases. The majority of meningiomas occur sporadically (without a clear inherited reason). However, several risk factors have been identified that increase a person's likelihood of developing one:
- Radiation exposure: This is the most established environmental risk factor, particularly therapeutic radiation to the head.
- Neurofibromatosis type 2 (NF2): This is the strongest genetic link; individuals with NF2 have a significantly increased risk of developing multiple meningiomas.
- Female sex hormones: Meningiomas are more common in those assigned female at birth, suggesting a role for hormones like estrogen and progesterone.
- Age: The risk increases with age, most commonly diagnosed in older adults.
Can meningioma cause nosebleeds?
No, meningiomas typically do not directly cause nosebleeds. Nosebleeds (epistaxis) are most commonly caused by local irritation, dryness, trauma, or underlying conditions like high blood pressure or clotting disorders.While a meningioma could, in extremely rare circumstances, be very large and invasive in a way that disrupts structures near the nasal cavity, it is not a characteristic or direct symptom of meningioma. If you are experiencing nosebleeds, it's highly unlikely to be related to a meningioma, and you should consult a doctor to identify the actual cause.
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