Meningiomas

It is one of the most common benign intracranial tumors that comprises of 10-15% of all the brain tumors. Still, there can be a very small percentage of malignant meningiomas. The membrane-like structures that surround the spinal cord and the brain are called meninges. Meningiomas develop in the meninges. They can be of different types such as:

  • Simple convexity meningioma
  • Complex skull base meningioma and
  • Intra-ventricular meningioma

Meningiomas are usually curable with Grade 0 to Grade 1 removal methods. The tumor may cause pressure on the spinal cord as well as the brain. Specific parts of the brain, nerves, or blood vessels surrounding the tumor may be affected by direct pressure from the tumor. Constant direct pressure may cause thickening of the adjacent bone or hyperostosis. In rare cases, it may even cause bone erosion. Meningiomas cannot be diagnosed until symptoms start to appear.
Common signs and symptoms of meningiomas are:

  • Vomiting
  • Convulsions or seizures
  • Severe headache
  • Blurred vision
  • Memory or personality changes etc.

Meningiomas that occur in different locations may show different symptoms:

Flax and Parasagittal Meningioma:

  • Weakness of the lower limbs
  • Difficulty in walking

Convexity Meningioma:

  • Convulsions
  • Headaches
  • Focal neurological deficits. That is a loss or paucity of optimal function of body parts.
  • Behavioral changes or memory lapses especially difficulty in registration and recall of recent events.

 

Sphenoid wing Meningioma:

  • Changes in the begaviour or memory loss. Difficulty in remembering even latest events.
  • Sensational inability or numbness paralysis on one side of the face.
  • Visual defects- blindness, double vision etc.

Oflactory Groove Meningioma:

  • Visual defects- blindness, double vision etc.
  • Changes in the begaviour or memory loss. Difficulty in remembering even latest events.
  • Sensational inability or numbness paralysis on one side of the face.

Posterior fossa Meningioma:

  • Hearing impairment
  • There can be difficulty in walking because of imbalance
  • Difficulty in coughing and swallowing
  • Numbness on the face, twitching or spasms on the facial muscles, electric shock pain on one side of the face etc.

Suprasellar or planum Meningioma:

  • Visual impairments or difficulties like blindness or double vision.
  • Visual signs and symptoms

Spinal Meningioma:

  • Reduced bowel or bladder functioning.
  • Weakness and numbness on the legs and/or arms.
  • Back pain which may increase when lying down.
  • Band like sensation in trunk or chest or pain in the limbs

Intraorbital Meningioma:

  • Vision impairment
  • Bulging of the eye

Intraventricular Meningioma:

  • Memory or behavioural changes

Intravenricular Meningioma:

  • Dizziness
  • Headaches
Diagnosis

Meningiomas are slow growing tumors and it is difficult to diagnose them until they start exerting pressure on the surrounding structures. The primary stage symptoms and signs may be confused with other medical conditions.
Common diagnostic tools are:

  • CT scan
  • Contrast enhanced MRI
Treatment Options

Surgery

Main and best option is the complete Micro-surgical removal of the tumor. This may achieve the best cure. The main aim of the surgery is to remove the meningioma completely along with the dural attachment and infiltrated bone. Removing the tumor completely can be very risky when it has infiltrated the veins or brain tissue or has absorbed the small arteries. Even though the main goal of the surgery is to remove the tumor completely, patient’s safety is the first priority. If the complete removal possesses risk, it is better to leave some of the tomor unremoved. This will help in observing the growth with imaging tests. If there are any changes in residual tumor, the patient will be givem a sterotectic radiation therapy later on. Risk of bleeding can be decreases with preoperative embolization.

Observation

Patients may require observation after the surgery in cases such as:

  • Aged patients with very slow-developing symptoms.
  • Patients who can get cured with an alternative treatment and do not opt surgery.
  • Patients with very small tumor, few symptoms and little or no swelling in the adjacent brain areas.
  • Patients who may carries potential risks with surgery.

Outcome

The best possible result in adults can be predicted during the time of diagnosis itself. The prognosis can be better in younger adults. Better results can be achieved if the tumor is removed completely. It cannot be possible in all cases.