Meningioma

What is a meningioma?

Meningiomas are divided into three grades:

• Grade I: Grade I meningioma is by far the most common. More than 85 percent of all meningiomas are grade I tumors, which are benign and grow very slowly. As a result, symptoms only appear late.
• Grade II: These meningiomas often grow somewhat faster and have a tendency to return after surgery. Grade II meningiomas are therefore referred to as atypical meningiomas.
• Grade III: Only two to three percent of all meningiomas, i.e. a small proportion, are so-called anaplastic meningiomas. Their typical characteristics: They exhibit malignant and often rapid growth behavior.

Meningioma: causes and risk factors

Meningiomas originate from certain cells in the meninges that begin to grow excessively and uncontrollably. It is not yet known what triggers this overactivation. However, two risk factors are certain:

1. Radiotherapy of the brain in childhood, for example because of cancer. This treatment appears to increase the likelihood of developing a meningioma after several years.
2. If the hereditary disease neurofibromatosis type 2, also known as Recklinghausen’s disease, is present, the risk of meningiomas also increases. Sometimes more than one tumor focus develops. The medical term for this accumulation is

Symptoms: From headaches to cramps and paralysis

Because in the vast majority of cases it is a slow-growing meningioma, i.e. grade I, the symptoms only appear as the disease progresses. These signs are often non-specific, such as headaches, which can also have many other causes. Depending on the location and size of the tumor, other neurological symptoms may occur. They depend crucially on the area in which the tumor grows and which structures in the brain it presses against. For example, if the meningioma forms in the movement center of the brain, this can lead to paralysis. Other possible symptoms of a meningioma are

• Change of character, a peaceful character becomes an aggressive type, for example
• Sensory disorders, such as numbness in some areas of the body or tingling
• Speech disorders
• Vision problems
• Convulsions, epileptic seizure
• Gait disorders, gait instability

Meningioma: Diagnosis at the USZ

If you experience neurological symptoms, you will find contact persons at the Neurology Clinic. After an appropriate medical history has been taken, the neurological examination follows. We check the physical and neurological changes. This includes reflex tests and other examinations depending on the symptoms. In the case of visual disorders, for example, the visual field is measured.

Further examinations are often carried out afterwards. If a meningioma is suspected, this is an imaging procedure to visualize the head and spinal canal:

• Computed tomography (CT)
• Magnetic resonance imaging (MRT / MRI)
• If necessary: angiography, i.e. X-ray of the blood vessels in the head, to identify the vessels that supply the tumor or that are being squeezed by it. This can also be important for the subsequent operation.
• Positron emission tomography (PET/CT or PET/MR) with ^{68Ga-DOTATATE} (if recurrence is suspected or for radiotherapy planning)

Meningioma: prevention, early detection, prognosis

There are currently no known ways of preventing meningiomas, partly because there are still few facts about the causes of these brain tumors. Therefore, no prevention tips can be given that would reduce the risk of brain tumors.

However, it is generally advisable to avoid any form of superfluous radiation, e.g. in the context of medical therapy. This precautionary measure is particularly important for children. Because prevention is virtually impossible, you should be aware of possible symptoms and have them checked out by a doctor as soon as possible.

Course and prognosis

The prognosis for a meningioma depends on its grade. For example, small tumors that look harmless on imaging and probably correspond to a grade I tumor may not require any treatment at all. It is sufficient to observe this tumor carefully and wait to see how and whether it develops. Only when a clear growth tendency can be recognized is therapy necessary. These tumors can usually be easily removed surgically. In the case of larger tumors, surgical removal is usually recommended immediately.

In the other two forms of meningioma, i.e. grade II and grade III, the course and prognosis are not quite as favorable. Here too, surgery is the first priority, not least in order to be able to make a clear diagnosis. Atypical and anaplastic meningiomas tend to recur even after initially successful treatment. The tumor can therefore form again after therapy. This is why follow-up care is absolutely necessary for these tumors. This includes regular follow-up checks in order to recognize the further course of the disease and to be able to react to a recurrence as early as possible. Your doctor will discuss the check-up intervals with you.

Meningioma: treatment with surgery and radiotherapy

The treatment of a meningioma depends on the size of the tumor, the symptoms it causes, the area of the head in which it is located and the grade to which it is assigned. Regular follow-up checks with imaging procedures (usually MRI) are recommended.

Meningioma: drug treatment

There are no established drug treatments for meningiomas. However, attempts can be made to treat malignant meningiomas that continue to grow despite repeated surgery and radiotherapy. Our specialists will advise you on the available options in this regard.