Meningioma
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A meningioma is an almost always benign brain tumor. Compared with other tumors of the central nervous system, it usually grows slowly. A meningioma does not develop directly from nerve cells. It is a tumor of the meninges, the protective membranes around the brain and spinal cord. It develops from cells of the arachnoid layer. This is a thin membrane that surrounds the brain and spinal cord from the outside. It lies between the dura mater and the pia mater. From there, a meningioma typically grows inward toward the brain. In simple terms, the tumor sits on the brain instead of growing out of the brain tissue itself.
In most cases, a meningioma is found by chance. It often appears as a single tumor in one defined area. Only rarely do several meningiomas occur at the same time. Their size can vary greatly. Some are only a few millimeters wide, while others grow to several centimeters. Larger tumors are usually more likely to cause symptoms. This happens when they take up space and press on nearby brain tissue.
Because meningiomas often grow slowly and are frequently benign, treatment can vary widely. Small meningiomas that cause no symptoms may first be monitored with regular check-ups. Larger tumors, or tumors in difficult locations, can cause neurological problems, seizures or headaches. In these cases, targeted treatment may become necessary.
Prof. Dr. med. Dipl.-Med. Holger Wehner
A meningioma requires careful and individualized treatment planning. Complementary approaches such as hyperthermia may help support the body and enhance well-being during treatment.
Meningioma causes and risk factors
The exact cause of a meningioma usually cannot be traced back to one clear factor. Over a lifetime, genetic changes can build up in the cells of the meninges. These changes may cause the cells to divide in an increasingly uncontrolled way. Still, some factors are known to increase the risk of a meningioma, or to occur more often with this diagnosis. These include:
- Older age
- Female sex
- Hormonal influences
- Certain inherited disorders, such as neurofibromatosis type 2
- Previous high-dose radiation to the head
- Obesity or excess weight
- Rare family clusters without a clearly identified syndrome
Even when these risk factors are linked to meningioma, this does not mean that a meningioma will definitely develop. Often, several factors come together. These may include personal predisposition, aging processes and possibly external influences. Many of these factors can only be influenced to a limited extent. The main focus is therefore to classify the tumor and the personal risk as precisely as possible. This helps doctors plan and adapt treatment individually.
Meningioma symptoms
Meningiomas usually grow very slowly. They often lie directly on the surface of the brain or along the meninges. For this reason, they can remain unnoticed for a long time. They are often found by chance during tests done for another reason. As long as the tumor is small and does not press on nearby brain tissue, it often causes no symptoms. Meningioma symptoms usually appear only when the tumor has grown larger or presses on a sensitive brain area. The type of symptoms also depends on the location, growth pattern and size of the tumor. Possible symptoms include:
- Headaches, often dull, chronic or increasing over time
- Epileptic seizures
- Vision problems
- Hearing loss, tinnitus or dizziness
- Paralysis or weakness in individual limbs
- Sensory changes in certain body areas
- Speech problems
- Changes in personality or behavior
- Problems with balance and coordination
- Signs of increased pressure in the skull, such as nausea, vomiting, increasing tiredness or changes in consciousness
A typical feature of meningiomas is that symptoms often develop slowly. They may increase over time. Still, some warning signs may point to a tumor. These include new, persistent or worsening neurological problems. Such symptoms should always be checked by a doctor. This helps clarify the underlying cause. However, not every symptom listed above means that a meningioma is present. In many cases, the symptoms may have harmless causes.
Meningioma diagnosis
A meningioma is often found during imaging that was not specifically looking for a tumor. This is why meningiomas are often described as incidental findings. It is important to know that a meningioma usually does not arise from the brain tissue itself. It starts in the meninges. This often gives it typical features on imaging scans.
The most important imaging test is magnetic resonance imaging, or MRI. It is usually done with a contrast agent. On MRI, a meningioma often appears as a clearly defined tumor attached to the meninges. The tumor typically absorbs a lot of contrast agent. MRI can also show the tumor size and exact location. It can show whether brain swelling is present and which brain areas are under pressure. A CT scan can also be helpful. It may show bone changes or calcifications more clearly.
A neurological examination is often added to the imaging tests. It checks whether the tumor affects functions such as vision, hearing, speech, strength or balance. The final diagnosis of a meningioma is made by histology after tumor tissue has been removed. The tissue is examined under a microscope. This helps determine whether the tissue is benign or malignant.
For the first assessment and treatment planning, typical imaging findings are often very important. They show the size, location and possible effects of the tumor clearly.
Meningioma treatment and prognosis
Meningioma treatment mainly depends on the tumor size, exact location, growth behavior and symptoms. Meningiomas usually grow slowly and are often found by chance. Unlike malignant brain tumors, they do not always need immediate treatment. Smaller meningiomas that cause no symptoms can often be monitored first. This is usually done with regular MRI scans.
If the meningioma continues to grow, causes symptoms or lies in a difficult brain area, surgery is often the most important treatment. This applies especially when the tumor is near important nerves, blood vessels or sensitive functional areas. The goal is to remove the tumor completely while protecting nearby brain tissue, nerves and vessels. This is why the exact location of the meningioma is especially important. In areas that are easy to reach surgically, the tumor can often be removed completely. In tumors at the skull base or near important cranial nerves, a small tumor remnant may sometimes need to remain. This can help avoid neurological damage.
Radiation therapy is mainly used when a tumor cannot be safely removed, when tumor tissue remains or when a meningioma grows again. Doctors usually use stereotactic radiosurgery or fractionated radiation therapy. Radiation is also an important part of treatment for more aggressive forms of meningioma.
Alongside conventional medical treatment, complementary medicine approaches may also be used for meningiomas. Their main aim is to relieve symptoms and support well-being. Approaches such as acupuncture and movement therapy are often discussed. They may help patients cope better with headaches, inner restlessness, sleep disorders or emotional stress during diagnosis and treatment.
Hyperthermia is also discussed in connection with meningiomas. However, it is important to distinguish hyperthermia from laser interstitial thermal therapy. For classic oncological hyperthermia as a complementary medical approach, there is currently no clear clinical evidence for meningiomas. Nevertheless, we offer this non-invasive procedure as a supportive component. Our aim is to use controlled warming to promote local blood flow and gently stimulate the immune system. This is intended to support standard therapies and quality of life as well as possible.
Laser interstitial thermal therapy, or LITT, is a specialized, minimally invasive neurosurgical procedure. It uses heat to treat tumor tissue under MRI guidance. LITT is mainly being studied for individual recurrent meningiomas or tumors in difficult locations.
The overall meningioma prognosis is good, especially for slow-growing WHO grade 1 tumors. These make up the largest group of meningiomas. Many of these tumors can be monitored for a long time. After complete removal, they can often be controlled permanently. The chance of cure is especially high when a benign meningioma can be removed completely. More aggressive forms often grow faster, recur more often and require closer monitoring. In these cases, the prognosis is usually less favorable.
Dr. med. Karsten Ostermann M.A.
In meningioma care, tumor characteristics, symptoms, and individual circumstances should be considered as a whole. An integrative approach can help tailor treatment strategies to each patient’s specific needs.
Further information
The information listed contains relevant topics and serves to improve understanding.