Meningioma (Brain Membrane Tumor)
The most common brain tumor originating from the brain membranes, usually benign
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Neuro-Oncology: Brain Tumors
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1Overview
Quick and clear information for patients
What is this Condition?
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Related Video · Meningioma — Hasta Yolculuğu · 0:27
Symptoms
Slowly beginning, progressively increasing headache - usually localized to the area where the tumor is located
Seizures - particularly in tumors close to the brain surface, may be the first symptom
Weakness or numbness on one side of the body - due to tumor compression on the motor control area
Vision problems - when the tumor is located near the visual pathways
Loss of smell - in tumors located near the lower part of the frontal lobe
Personality changes and mental slowness - in large, anterior fossa tumors
Hearing loss or tinnitus - in tumors in the posterior fossa of the brain
Facial numbness or weakness - in certain skull base tumors
Diplopia - in tumors near the nerves controlling eye movements
Balance disturbance and unsteady gait - in tumors in the posterior fossa of the brain
Diagnosis Methods
Treatment Methods
Microsurgical Resection (Tumor + Dura + Affected Bone)
Stereotactic Radiosurgery (Gamma Knife / CyberKnife) - Small, Deep, High Surgical Risk Tumors
Surveillance (Watch-and-Wait) - Asymptomatic, Small Tumors and Elderly Patients
Conformal Radiation Therapy - Intermediate/Malignant or Subtotally Resected Tumors
Preoperative Vessel Occlusion - To Reduce Bleeding in Highly Vascular Large Tumors
Pharmacologic Therapy - Recurrent/Progressive Intermediate or Malignant Tumors
Frequently Asked Questions About Meningioma (Brain Membrane Tumor)
Q1.Is meningioma cancer? Is it benign or malignant?▼
The vast majority of meningiomas are benign tumors and are not cancer. They grow slowly, do not spread to other parts of the body, and usually do not recur when completely removed. Intermediate meningiomas grow more rapidly and have a higher recurrence likelihood. Malignant meningiomas are quite rare and represent the most aggressive type. The tumor grade is determined by microscopic examination of tissue obtained during surgery.
Q2.Can meningioma be observed without surgery? In which cases is surveillance appropriate?▼
Yes, many meningiomas can be safely observed without surgery. Surveillance is generally appropriate in the following cases: asymptomatic, small-sized tumors, and those incidentally discovered on imaging performed for other reasons, particularly in elderly patients or those whose general condition makes surgery unsuitable. Growth is monitored with annual MRI. Many tumors do not grow at all. If growth accelerates, symptoms develop, or brain compression occurs, treatment is planned.
Q3.Is meningioma surgery dangerous? What are the risks?▼
Surgery for meningiomas on the brain surface is generally lower risk. However, skull base, midline, or brainstem-adjacent tumors are technically more challenging with higher risk. Possible risks include hemorrhage, infection, cerebrospinal fluid leak, nerve injury, temporary or permanent neurological deficits, and seizures. In experienced centers, navigation and neuromonitoring techniques used during surgery attempt to minimize these risks. Risks are individually assessed based on tumor location and size.
Q4.Why is the extent of tumor resection during surgery important? How is recurrence likelihood determined?▼
The extent of complete tumor resection achieved during surgery is one of the most important factors determining future recurrence likelihood. When the tumor, involved dura, and affected bone are completely removed together, recurrence likelihood is lowest. When only part of the tumor is removed, this likelihood increases. Therefore, complete resection is the goal whenever possible. In intermediate and malignant tumors, adjuvant radiation therapy following surgery reduces recurrence likelihood.
Q5.Is Gamma Knife effective for meningioma treatment? Which tumors are suitable?▼
Yes, radiosurgery methods such as Gamma Knife are effective options for small-to-medium sized, deeply located, or surgically high-risk meningiomas. The rate of halting tumor growth is high. It is particularly preferred in tumors located in regions where surgery carries high risk of nerve damage, and in elderly patients or those with comorbidities. After treatment, the tumor typically does not shrink but growth halts. Regular MRI is performed during follow-up.
Q6.Does meningioma grow during pregnancy?▼
Some meningiomas may be hormone-sensitive and can grow faster due to hormonal changes in pregnancy; some tumors may even present symptomatically for the first time during pregnancy. In women with known meningioma, evaluation before pregnancy is beneficial. Meningiomas discovered during pregnancy are generally deferred until after delivery if there are no severe symptoms. Many meningiomas may shrink or stabilize after delivery.
Q7.Does meningioma recur? What is done if it recurs?▼
Recurrence likelihood depends on tumor grade and the extent of resection achieved. In benign completely resected tumors, this likelihood is low; when part of the tumor remains or in intermediate and malignant tumors, the likelihood increases. If recurrence occurs, options include: repeat surgery if feasible, radiation therapy or radiosurgery if not previously given, some pharmacologic therapies (with limited effects), and research studies. In high-grade tumors, recurrence may be more frequent and earlier.
Q8.How are intermediate and malignant meningiomas treated?▼
In intermediate meningiomas, treatment consists of maximal tumor resection followed by conformal radiation therapy; this adjuvant treatment reduces recurrence likelihood. In malignant meningiomas, aggressive surgery followed by radiation therapy is mandatory, and some centers add pharmacologic therapy. Close follow-up is essential because recurrence likelihood is high in these tumors. Pharmacologic therapies are under investigation in this group with limited effects.
Q9.Is spinal meningioma different from brain meningioma?▼
Spinal meningioma arises from the membranes surrounding the spinal cord and comprises an important portion of spinal tumors. It is much more common in women and most frequently occurs in the thoracic region. These are generally benign and slow-growing tumors. Symptoms include back pain, weakness, numbness, balance disturbance, and urinary/bowel dysfunction. Diagnosis is made with contrast-enhanced spinal MRI. Treatment is microsurgical resection, and the complete resection rate is higher than for brain meningiomas. The prognosis is generally excellent; recurrence likelihood is low after complete resection and most patients show neurological improvement.
Q10.How should meningioma surveillance be conducted?▼
Follow-up varies according to the treatment applied and tumor grade. In benign completely resected tumors, more frequent MRI in the first year, then annual MRI; if no problems occur within a few years, intervals can be lengthened. If part of the tumor remains or radiosurgery was performed, more frequent MRI is required. In intermediate and malignant tumors, surveillance is much closer. In observed (unoperated) tumors, annual MRI is sufficient; if growth accelerates, intervals are shortened. If new neurological symptoms appear, urgent evaluation is necessary.
References
- Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023:807-818.
- Black PM, Wen PY. Meningiomas. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011:1426-1435.
- Surgical Management of Parasagittal and Convexity Meningiomas. In: Quiñones-Hinojosa A, ed. Schmidek and Sweet Operative Neurosurgical Techniques. 7th ed. Elsevier; 2021:281-284.
- Huang AP, Medani K, Black PM. Outcomes and Quality of Life after Surgery for Meningiomas. In: DeMonte F, McDermott MW, Al-Mefty O, eds. Al-Mefty's Meningiomas. 2nd ed. New York: Thieme; 2011:413-414.
This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.
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