• Meningioma

    Definition

    The meninges are a protective lining around the brain and spinal cord. A meningioma is a tumor of these linings. Most meningiomas do not cause symptoms. But, if the meningioma grows, it can push on important parts of the brain. This may lead to symptoms such as vision problems, seizures, weakness, or language problems. These tumors may be grade I, II, or III. Type III is the most aggressive type.
    Malignant meningiomas (also called anaplastic or grade III) are less common. These tumors are faster growing. They often cause problems and can cause some swelling in the brain.
    Some meningiomas may require some form of therapy, surgery, and/or radiotherapy. The treatment will depend on the location of the tumor.
    Meningioma
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    Causes

    The exact cause of meningiomas is unknown. Factors that may be associated with these tumors include:
    • Genetic predisposition
    • Certain hormones—may increase the growth of meningiomas.

    Risk Factors

    Factors that may increase the risk of meningioma include:
    • Sex: twice as common in women than men
    • Age: 40-70
    • History of breast cancer or sarcoma, as part of the Li-Fraumeni syndrome
    • A diagnosis of neurofibromatosis type 2 (NF2)
    • Radiation exposure, especially to the head

    Symptoms

    Symptoms of meningioma are usually related to the area of the brain that is affected. Symptoms can also be due to an increase in the pressure inside the skull. Symptoms may include:
    • Headaches
    • Vomiting
    • Visual problems
    • Changes in behavior
    • Seizures
    • Pain
    • Loss of sensation or weakness in the arms and legs
    • Loss of bladder or bowel control
    • Slurred speech
    • Language deficits
    • Difficulty with learned movements
    • Loss of coordination
    • Difficulty writing
    • Cognitive difficulty

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You will have a neurologic examination. Other tests may include:
    • CT scan —a type of x-ray that uses a computer to make pictures of the inside of the body, in this case the head
    • MRI scan —a test that uses magnetic waves to make pictures of the inside of the body, in this case the head
    • Angiogram —the injection of a special dye to highlight blood vessels in the brain
    • Electroencephalogram (EEG) —a test that records the brain's activity by measuring electrical currents through the brain
    MRI of Meningioma in the Brain
    Meningioma MRI
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    Treatment

    Treatment will depend on the size and location of the tumor, its rate of growth as well as your general health. The main types of treatment for meningiomas are:

    Surgery

    Surgery may be recommended if the tumor is located in an area that is easily reached. Most surgeries can be done without causing neurologic damage.

    Embolization

    Tumors need a blood flow to survive. In some instances, prior to surgery, a catheter may be inserted into blood vessels supplying the tumor. It will disrupt the flow of blood to the tumor. This will make the tumor shrink. The smaller tumor can then be removed with surgery.

    Radiation Therapy

    Radiation therapy is used either on its own or after surgery has been done.
    Some tumors may be located in an area the is difficult or to dangerous to operate on. Radiation may be used on its own if the tumor is causing symptoms and cannot be removed with surgery. The radiation therapy is an effective way of treating the tumor and stopping its growth.
    If the tumor is higher grade, radiation is generally considered. In this case, radiation may be given either on its own or after surgery to help prevent the tumor from coming back.
    Your radiation oncologist will describe how the therapy is delivered and how many treatments are needed. You may receive 25-40 treatments on a daily basis, or far fewer treatments if you are having stereotactic radiosurgery. This type of surgery delivers higher doses of radiation each treatment.

    Chemotherapy

    Chemotherapy is used only if other treatment modalities are no longer adequate. Your oncologist will discuss the options and choice of medications.

    Prevention

    There are no guidelines for the prevention of meningiomas.

    RESOURCES

    National Brain Tumor Society http://braintumor.org/

    National Cancer Institute http://www.cancer.gov/

    CANADIAN RESOURCES

    Brain Tumor Foundation of Canada http://www.braintumour.ca/

    The Canadian Brain and Nerve Health Coalition http://www.ccns.org/index.html

    References

    Greenberg HS. Meningiomas. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation. Available at: http://www.medlink.com . Accessed March 17, 2007.

    Meningioma. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 18, 2012. Accessed August 31, 2012.

    Meningioma. International radiosurgery association website. Available at: http://www.irsa.org/meningioma.html . Accessed August 31, 2012.

    Keller A, Ludwig N, Comtesse N, et al. H-P A minimally invasive multiple marker approach allows highly efficient detection of meningioma tumors. BMC Bioinformatics. 2006,7:539

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