Edit concept Create issue ticket

Meningioma

Brain Tumor Meningioma

Meningioma refers to one oR many tumors that arise in very close contact to the meninges. The meninges are the membranous layers that cover the brain and spinal cord.


Presentation

Symptoms of meningioma are produced via different mechanisms. By irritating the underlying cortex, they can cause seizures. Headaches, weakness, dysphasia, and apathy are some of the symptoms seen due to compression by the tumors. They may also produce symptoms relative to their position, e.g. a tumor in the foramen magnum will produce paraparesis and sphincteric trouble while one in the olfactory groove will produce symptoms like anosmia. If the meningiomas are located in the skull base, they may occlude the cerebral arteries and present as strokes or transient ischemic attacks. This is however rare [8].

Anosmia
  • In contrast, symptoms persisted in 60% of patients with anosmia, sensory changes, or frontal, temporal, or cerebellar symptoms.[ncbi.nlm.nih.gov]
  • Additional features may include headache, seizures, gradual personality changes (apathy and dementia), anosmia, impaired vision, exophthalmos, hearing loss, ataxia, dysmetria, hypotonia, nystagmus, and rarely spontaneous bleeding.[orpha.net]
  • They may also produce symptoms relative to their position, e.g. a tumor in the foramen magnum will produce paraparesis and sphincteric trouble while one in the olfactory groove will produce symptoms like anosmia.[symptoma.com]
  • Underneath the brain and behind the nose (olfactory groove) - loss of the sense of smell (anosmia). Underneath the brain and behind the eye (sphenoid wing) - seizures and multiple cranial nerve palsies.[betterhealth.vic.gov.au]
  • Location - Olfactory Groove and sella (bony space where the pituitary gland is situated) Common Symptoms - Loss of smell (anosmia), subtle personality changes, mild difficulty with memory, euphoria, diminished concentration, urinary incontinence, visual[neurosurgery.ucla.edu]
Diplopia
  • A 33-year-old female patient presented with diplopia and left eye ptosis 26 weeks into her first pregnancy. No investigation was conducted at the time and her symptoms subsided 4 weeks post partum.[ncbi.nlm.nih.gov]
  • He was presented to the emergency department for atypical angina and a seven-day history of dizziness when switching from clino- to orthostatism, reduced visual acuity, diplopia and vomiting.[ncbi.nlm.nih.gov]
  • She presented 4 years later with diplopia, and MRI showed an enhancing extra-axial mass measuring 47 mm in greatest dimension and centered on the tentorial incisura.[ncbi.nlm.nih.gov]
  • Diplopia (Double vision) or uneven pupil size may be symptoms if related pressure causes a third and/or sixth nerve palsy.[en.wikipedia.org]
Headache
  • Four months after the meningioma surgery, the patient presented with headaches, dysarthria, and dizziness. Indirect bypass surgery was performed. He has been free from headaches since one month after the surgery.[ncbi.nlm.nih.gov]
  • She had continued left-sided headaches but no longer complained of visual changes. A postpartum surgical resection via left occipital and suboccipital craniotomy was planned.[ncbi.nlm.nih.gov]
  • Patients presented primarily with headaches (48.2%) and either cerebral dysfunctions (48.5%) with convexity meningiomas or cranial nerve deficits (38.9%) with skull base meningiomas.[ncbi.nlm.nih.gov]
  • FTM (n 16) were typically supratentorial, large, edematous tumors that caused mainly headache and hemianopia; TM (n 12) were infratentorial, smaller not edematous tumors that caused mainly headache and gait ataxia.[ncbi.nlm.nih.gov]
  • Headache was improved in 40%, resolved in 10%, unchanged in 50%. Epilepsy was resolved in 17%, unchanged in 33%, worsened in 33%.[ncbi.nlm.nih.gov]
Seizure
  • Few studies focus on seizure outcomes after resections of meningiomas.[epilepsy.com]
  • General symptoms General symptoms from the tumor pressing on the brain or spinal cord: Seizures. Motor seizures, also called convulsions, are sudden involuntary movements of a person’s muscles.[cancer.net]
  • Although seizures and focal neurologic deficits are considered to be the most prevalent symptoms, depression also may be an important and significant sign.[ncbi.nlm.nih.gov]
  • With the help of seizure medication, he resumed normal activities. However, the following Christmas, he had another seizure and was hospitalized. Paul’s doctors altered his meds. Unfortunately, this did not work.[gammaknife.com]
  • Seizures are a common symptom of cortex irritation. Invasion - the tumour may invade brain tissue. Symptoms depend on which parts of the brain are affected.[betterhealth.vic.gov.au]
Dizziness
  • A 21-year-old man presented with generalized headache and dizziness for the past 6 months and worsening of symptoms for the past 2 months.[ncbi.nlm.nih.gov]
  • Four months after the meningioma surgery, the patient presented with headaches, dysarthria, and dizziness. Indirect bypass surgery was performed. He has been free from headaches since one month after the surgery.[ncbi.nlm.nih.gov]
  • A 14-year-old girl was admitted at our hospital with a 3-month history of dizziness, slowly progressing headache, and 2-month history of instability in walking.[ncbi.nlm.nih.gov]
  • The patient was admitted to our hospital with sudden left limb paralysis combined with complaints of headache and dizziness. Histopathological results confirmed the lung metastases derived from intracranial bleeding meningioma.[ncbi.nlm.nih.gov]
  • He was presented to the emergency department for atypical angina and a seven-day history of dizziness when switching from clino- to orthostatism, reduced visual acuity, diplopia and vomiting.[ncbi.nlm.nih.gov]
Confusion
  • The unusual features of the case include the location of the tumor, patient age, the erosion of the vertebra, and the confusing neuroradiological features.[ncbi.nlm.nih.gov]
  • Meningiomas that arise over the surface of the frontal, temporal, parietal or occipital lobes may cause a variety of symptoms including headache, seizures, visual loss, double vision, weakness, fatigue, difficulty walking, confusion and personality changes[pacificneuroscienceinstitute.org]
  • Back on Her Feet Thanks to CSF Leak Repair A cerebrospinal fluid leak caused Beth Johnson’s brain to shift and sag away from her skull when she tried to stand, leading to severe headaches and periods of confusion.[braintumortreatment.com]
  • The most common symptoms from a meningioma are: Headache Hearing loss Facial numbness Balance disturbance/vertigo Weakness on one side Seizures Personality and behavioral changes Confusion Mengiomas that occur in the foramen magnum can cause weakness[uwmedicine.org]
  • […] followed by twitching and relaxing muscle contractions Loss of control of body functions May be a short 30-second period of no breathing and the person may turn a shade of blue After this type of seizure a person may be sleepy and experience a headache, confusion[cancer.net]
Focal Neurologic Deficit
  • Although seizures and focal neurologic deficits are considered to be the most prevalent symptoms, depression also may be an important and significant sign.[ncbi.nlm.nih.gov]
  • Symptoms of a convexity meningioma are seizures, focal neurological deficits, or headaches.[brighamandwomens.org]
  • Symptoms of meningiomas may include any of the following: Headaches Seizures Change in personality or behavior Progressive focal neurologic deficit Confusion Drowsiness Hearing loss or ringing in the ears Muscle weakness Nausea or vomiting Visual disorders[aans.org]

Workup

  • Imaging studies are the mainstay and laboratory investigations have no use in screening for meningioma. Imaging studies include plain skull radiograph which may show hyperostosis, intracranial calcifications and increased vascular markings of the skull.
  • Plain cranial CT scan will show isoattenuating to slightly hyperattenuatingdural based tumors that enhance after injection of contrast. It will also show perilesional edema, hyperostosis and intratumoral calcification if present.
  • MRI will show edema better than a CT, the meningiomas also enhance more intensely and homogenously after injection of contrast.
  • Angiography is used pre-operatively to assess the vascular supply of the tumor and will show features like sun-burst appearance of the feeding arteries.
  • Histological assessment of the tumor will help to unequivocally diagnose meningioma.
Slowing
  • Meningiomas generally present as slow-growing, expanding intracranial lesions and are the most common benign intracranial tumor in adults.[ncbi.nlm.nih.gov]
  • BACKGROUND Meningiomas are slow-growing tumors attached to the dura mater and are composed of neoplastic meningothelial cells.[ncbi.nlm.nih.gov]
  • Meningioma is slow-growing benign neoplasm that derived from the meningothelial cells of the arachnoid mater, and it is the most common type of primary brain tumor.[ncbi.nlm.nih.gov]
  • Intraoperative blood transfusion should be considered in prolonged surgeries in the lateral position, where slow blood loss over a long period could be a contributing factor to development of PION.[ncbi.nlm.nih.gov]
  • Meningiomas are common in intracranial tumors, the majority of which are benign with slow growth and low recurrence rate.[ncbi.nlm.nih.gov]

Treatment

The gold standard for treatment for treatment of a benign meningioma surgical resection. Medical care is only used for perioperative medication or when other methods of treatment have failed considerably. Corticosteroid use for example greatly decreases the morbidity and mortality associated with resection. Antiepileptic drugs are also used pre and postoperatively in supratentorial surgery [9].

The general principles in surgical resection of meningiomas are: remove all involved and hyperostotic bone if possible. The dura involved with the tumor as well as its rim that is tumor free should be resected and a duroplasty performed. If dura tails are seen on MRI, they should be removed even if they are not involved with the tumor.

Radiotherapy therapy is used as primary treatment for some unresectable tumors. It is also used as adjuvant therapy for incompletely resected tumor and recurrent tumors.

Prognosis

The size of the tumor may have a role to play in determining the outcome. Studies have revealed permanent cranial nerve deficits is seen in up to 45.5% of patients who have tumors greater than 3cm. In patients with tumors less than 3cm, only about 6% show permanent cranial nerve deficits. If the neoplasm extends into the lower jugular foramen, there could be deficit of the lower cranial nerves.
The prognosis is generally excellent in patients who have had their meningiomas completely resected. However, if the tumors are incompletely resected, multiple or malignant, there is an increased likelihood of recurrence [7].

Etiology

The cause of these tumors have not been fully understood. They are believed to be familial but many cases have arisen randomly, arising sporadically. However, there appears to be an increased risk of developing meningioma in patients who have suffered brain injury or received radiation to the scalp. There is also an increased risk with heavy mobile phone use and with frequent dental x-rays [2].

Patients with neurofibromatosis type 2 also have an increased risk of developing meningioma. There are also genetic mutations that have been associated with meningioma [3].

Epidemiology

In the United States, the annual frequency of symptomatic meningioma is 2 in 100000. It accounts for 20% of all primary intracranial tumors. In Africa, it is responsible for 30% of all intracranial tumors. The morbidity and mortality is difficult to assess but the 5-year survival rate is assumed to be around 73 – 94%. They have a higher prevalence in Africans and African-Americans than in Caucasians. It is more commonly found in women than in men with a male to female ratio of up to 1 : 2.8. The incidence of meningioma increases with age from as low as 0.12 in patients younger than 19 years to as high as 18.89 in patients older than 85 [4, 5].

Sex distribution
Age distribution

Pathophysiology

These tumors may grow within the brain or within the spinal cord. They are widely thought to originate from the arachnoid cap cells which are in the arachnoid layer covering the external part of the brain. Most meningiomas are seen on the brain surface, either at the skull base or over the convexity of the brain. In rare occasions, the may have an intraosseous or intraventricular origin. Classifying meningiomas is problematic because arachnoid cells may exhibit both epithelial and mesenchymal features, and similar tumors may arise from other mesodermal structures.

The classification of all these tumors together is contentious. The current inclination is to separate tumors that are definitely meningiomas from other less well-defined or poorly defined neoplasms. It is however expected that with the advances in molecular biology, scientist will be able to identify the exact anomaly in a genome that is responsible for each specific tumor [6].

Prevention

There are no known ways to prevent this condition. Avoidable risk factors like heavy mobile phone use should however be prevented as much as possible [10].

Summary

Meningiomas are typically benign in nature with only a few percentage turning malignant. They are also asymptomatic in many instances and some individuals carry them their whole life without realizing. They are usually found when investigation for other conditions or during an autopsy [1].

Patient Information

Definition: Meningioma is used to define any of many tumors that grow very close to the meninges. The meninges are the covering of the brain and spinal cord. They are usually benign and many people live and die without knowing that they have it.

Cause: It is believed to have a genetic link but some cases arise randomly. Factors that could increase chances of getting this condition and increased exposure to radiation like mobile phones and dental x-rays. Also, patients who have had a brain injury have an increased risk of developing this condition.

Symptoms: The symptoms are numerous and are determined by the location of the tumor and/or the effect it is having on the brain. They range from the milder headaches and weakness to severe symptoms like paraparesis and stroke.

Diagnosis: This is mainly by the use of imaging tests like x-rays, CT scans and MRI. Some of the sample of the tumor will also be sent to the lab for histology.

Treatment: The main treatment is mainly surgical removal of the tumor. Drug treatment may be used to reduce the operative risk and postoperative complications.

References

Article

  1. Cushing, H, Eisenhardt, L. Meningiomas: Their Classification, Regional Behavior, Life History and Surgical End Results, Thomas, Springfield 1938.
  2. Claus EB, Calvocoressi L, Bondy ML, et al. Dental x-rays and risk of meningioma. Cancer 2012; 118:4530.
  3. Preston-Martin S, Yu MC, Henderson BE, Roberts C. Risk factors for meningiomas in men in Los Angeles County. J Natl Cancer Inst 1983; 70:863.
  4. Annegers JF, Schoenberg BS, Okazaki H, Kurland LT. Epidemiologic study of primary intracranial neoplasms. Arch Neurol 1981; 38:217.
  5. Ibebuike K, Ouma J, Gopal R. Meningiomas among intracranial neoplasms in Johannesburg, South. Afr Health Sci. Mar 2013;13(1):118-21.
  6. Weber DC, Lovblad KO, Rogers L. New pathology classification, imagery techniques and prospective trials for meningiomas: the future looks bright. Curr Opin Neurol 2010; 23:563.
  7. Lieu AS, Howng SL. Intracranial meningiomas and epilepsy: incidence, prognosis and influencing factors. Epilepsy Res 2000; 38:45.
  8. Hallinan JT, Hegde AN, Lim WE. Dilemmas and diagnostic difficulties in meningioma. Clin Radiol. Apr 25 2013;
  9. Liu Y, Li F, Zhu S, et al. Clinical features and treatment of meningiomas in children: report of 12 cases and literature review. Pediatr Neurosurg 2008; 44:112.
  10. Milham S. Meningioma and mobile phone use. Int J Epidemiol. Apr 22 2009;

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2017-08-09 17:49