Meningioma: making a decision about treatment

There are many ways to treat a brain tumour – but which is best? We spoke to Mr Christos Tolias, one of London's most highly-experienced neurosurgeons.

What is meningioma?

Meningioma is a type of brain tumour which develops within the meninges – the layers of tissue which cover and protect the brain. In many cases, meningiomas may involve any obvious symptoms, but symptoms that do appear can include:

• headaches
• memory problems
• weakness in the arms or legs
• seizures
• vomiting

Meningiomas usually tend to grow slowly, with a very low chance of regrowth after treatment. In rare cases, however, a meningioma can fast-growing and malignant tumour.

When you’re diagnosed with meningioma, you’re usually given a “grade”, with grade 1 indicating the slowest-growing type of tumour going up to grade 4.

Treatment options

If your meningioma is slow-growing, your doctors may recommend a “wait and see” strategy – where you have regular scans to check on the progression of the tumour and have treatment when you’re ready. Your treatment options can include:

Surgery

Surgery to remove a meningioma is relatively straightforward, but the risks can vary depending on the size of the tumour and where it is located. The procedure involves:

• scanning the brain to get a clear picture of the brain and the tumour
• checking to see if the tumour has grown into any blood vessels into the brain
• removing as much of the tumour as safely possible

The aim of surgery is to preserve your functioning, restore normal pressure in the brain, and following surgery monitor tumour regrowth (if at all).

You might need to stay in hospital for a couple of days afterwards, and recovery may involve a short-term program of physiotherapy.

Radiotherapy

Radiotherapy involves sending high-energy radio waves through the skull to destroy the tumour cells. Radiotherapy is generally carried out by an interventional radiologist, and can encompass a range of techniques and tools. Your doctor should discuss with you all of the options available and the risks and benefits of each.

Unfortunately as with other treatments there are some side effects to radiotherapy, and these can sometimes take years to emerge. However, radiotherapy is a useful alternative if the tumour is inaccessible or impossible to remove through surgery.

Chemotherapy

Lastly, chemotherapy can be a treatment option if you have a high grade meningioma which is fast-growing or coming back after previous treatment.

How do I decide on the right treatment for me?

The decision on when to have treatment, and which type of treatment to opt for, is always a difficult one. You may want to avoid the risks of treatment for as long as possible, or you might want to tackle the symptoms you’re experiencing now. All of the relevant factors should be discussed at length with your doctor.

Whatever treatment option you choose, a key part of good management is proper follow-up. You should be getting regular check-ups and MRI scans of your brain to check if the tumour has returned – and if so, how fast it’s growing. With proper management and care, you should be able to minimise the impact it has on your life.