What is a Meningioma?


A meningioma is a type of tumor that develops from the meninges, the membrane that surrounds the brain and spinal cord. Most meningiomas (90 percent) are categorized as benign tumors, with the remaining 10 percent being atypical or malignant. In many cases, benign meningiomas grow slowly. This means that depending upon where it is located, a meningioma may reach a relatively large size before it causes symptoms.

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Meningiomas account for about 27 percent of primary brain tumors, making them the most common tumor of that type. With May marking Brain Tumor Awareness Month, we’re looking at some common questions about meningiomas:

What are the risk factors of meningiomas?

Meningiomas are most common in people between the ages of 40 and 70, and are more common in women than in men. Meningiomas are very rare in children, with pediatric cases accounting for only 1.5 percent of the total. There are not many predisposing factors associated with the development of meningiomas, but a few include:

  • Previous trauma – Meningiomas have been found at the site of previous trauma (such as near a previous skull fracture, scarred dura, or around foreign bodies), but the relationship between trauma and meningioma risk isn’t fully understood.
  • Radiation – Exposure to radiation has been associated with a higher incidence of meningiomas.
  • Genetic predisposition – People with a genetic disorder known as neurofibromatosis type 2 (Nf2) are more likely to develop meningiomas.

 

What are the common symptoms of meningiomas?

Not all meningiomas are symptomatic, particularly if they are small or developed relatively recently. Patients with symptomatic meningiomas may experience:

  • Headaches
  • Blurred vision
  • Seizures
  • Numbness
  • Weakness in the arms or legs
  • Speech difficulty

 

What are treatment options for meningiomas?

There are generally three treatment options for meningiomas:

  • Observation – If a meningioma is small and asymptomatic in a person over 65, it may just be observed. Observation requires annual CT or MRI scans with contrast. Typically, asymptomatic meningiomas can be observed for a period of 3 to 12 months before a definitive treatment decision is made.
  • Surgery – Surgery is the primary treatment for meningiomas, and is tailored to the size and location of the tumor. Complete removal is the ideal result.
  • Radiotherapy – Several recent studies have  shown radiotherapy to control tumor growth by 50 to 90 percent. Newer forms of focal radiotherapy (such as radiosurgery, stereotactic radiotherapy, or intensity modulated radiotherapy) also are effective and minimize effects  of radiation on the surrounding brain tissue.

 

How successful is meningioma treatment?

Eighty percent of patients reported satisfaction with the quality of their lives after undergoing treatment. The location of a patient’s tumor within the brain is the most important factor in determining  the success of treatment. Due to their location, certain types of meningiomas (convexity, parasagittal and lateral sphenoid wing) usually are completely removable through surgery, yielding excellent results. Optic sheath and skull-based meningiomas can be more difficult to remove surgically. Older patients or those or in poor health prior to surgery may face additional challenges during treatment and recovery.

 

Where can I find support for myself or family member diagnosed with a meningioma?

Your physician can answer questions about meningioma diagnosis and help you select appropriate treatment options.  Additionally, there are many groups that provide ongoing support to patients and families living with meningiomas. The National Brain Tumor Society and the Brain Science Foundation provide a list of support groups on their websites.

This post originally appeared on the Brigham and Women’s Hospital HealthHub blog. For more information on brain tumors, visit the website for the Center for Neuro-Oncology at Dana-Farber/Brigham and Women’s Cancer Center.

Gamma Knife surgery for the treatment of patients with asymptomatic meningiomas.


Abstract

OBJECT

Increasingly, meningiomas are detected incidentally, prior to symptom development. While these lesions are traditionally managed conservatively until symptoms develop or lesion growth occurs, it is conceivable that patients at high risk for symptom development may benefit from earlier intervention prior to the appearance of symptoms. However, little research has been performed to determine whether Gamma Knife surgery (GKS) can alter the rate of symptom development in such patients.

METHODS

A retrospective case study was performed by screening the University of Virginia GKS database for patients treated for asymptomatic meningiomas. From the patient’s medical records, pertinent demographic and treatment information was obtained. Yearly follow-up MRI had been performed to assess tumor control and detect signs of radiation-induced injury. Clinical follow-up via neurological examination had been performed to assess symptom development.

RESULTS

Forty-two patients, 33 females (78.6%) and 9 males (21.4%), with 42 asymptomatic meningiomas were included in the analysis. The median age at GKS was 53 years. The most common lesion location was the cerebral convexities (10 lesions [23.8%]), and the median lesion size was 4.0 ml. The median duration of imaging and clinical follow-ups was 59 and 76 months, respectively. During the follow-up period, 1 tumor (2.4%) increased in size, 2 patients (4.8%) demonstrated symptoms, and 1 patient (2.4%) exhibited possible signs of radiation-induced injury. Thus, actuarial tumor control rates were 100%, 95.7%, and 95.7% for 2, 5, and 10 years, respectively. Actuarial symptom control at 5 and 10 years was 97% and 93.1%, respectively. Overall progression-free survival was 91.1% and 77.8% at 5 and 10 years, respectively.

CONCLUSIONS

Compared with published rates of symptom development in patients with untreated meningiomas, results in this study indicated that patients with asymptomatic lesions may benefit from prophylactic radiosurgery prior to the appearance of symptoms. Additionally, GKS is a treatment option that offers low morbidity.

Source: :  journal of neurosurgery

 

 

Successful treatment with azathioprine of relapsing Rosai-Dorfman disease of the central nervous system.


Rosai-Dorfman disease (RDD) is a rare non-Langerhans histiocytosis that usually presents with lymphadenopathy. Although isolated involvement of the CNS was considered to be uncommon, numerous cases have been reported in recent years. For RDD of the CNS, the treatment consists, in general, of surgery. In cases of partial resection or relapse, chemotherapy regimens, corticosteroids, and/or radiotherapy have yielded negative results. The authors describe the case of a 57-year-old man with a history of chronic Q fever who presented with aphasia and partial seizure. Computed tomography of the brain revealed a left frontotemporal lesion that was suggestive of a meningioma. The lesion was partially resected and histopathological evaluation revealed the presence of RDD. Nineteen months later, a Jacksonian seizure prompted MRI evaluation, which disclosed a local recurrence of the tumor. Computed tomography and FDG-PET demonstrated that the RDD involved no other site, but the presence of ileitis, noted on ileoscopy, led to the diagnosis of Crohn disease. Treatment with the purine analog azathioprine was initiated, leading to an objective and sustained response in both the RDD tumor and ileitis over 35 months of follow-up. This case report highlights the potential use of a purine analog in cases of relapsing RDD of the CNS and a possible common defect of macrophage regulation in RDD, Crohn disease, and Q fever.

Source: Journal Of Neurosurgery.

 

 

A nationwide cohort study on the incidence of meningioma in women using postmenopausal hormone therapy in Finland.


The authors conducted a nationwide cohort study to evaluate the association between postmenopausal hormone therapy and meningioma incidence in Finland. All women who had used hormone therapy at least for 6 months at the age of 50 years or older during 1994-2009 were included. Women who had used postmenopausal hormone therapy were identified from the medical reimbursement register of the Social Insurance Institution (131,480 estradiol users and 131,248 estradiol-progestin users), and meningioma cases were identified from the Finnish Cancer Registry. During the average 9 years of follow-up, 289 estradiol users and 196 estradiol-progestin users were diagnosed with meningioma. Ever use of estradiol-only therapy was associated with an increased risk of meningioma (standardized incidence ratio = 1.29, 95% confidence interval: 1.15, 1.44). Among women who had been using estradiol-only therapy for at least 3 years, the incidence of meningioma was 1.40-fold higher (95% confidence interval: 1.18, 1.64; P < 0.001) than in the background population. In contrast, this risk was not increased in users of combination therapy (standardized incidence ratio = 0.93, 95% confidence interval: 0.80, 1.06). There was no difference in risk between continuous and sequential use of hormone therapy. Estradiol-only therapy was accompanied with a slightly increased risk of meningioma.

Source: American Journal of Epidemiology.