Meningioma: What's the treatment process?

The treatment process for meningioma, a type of tumour that arises from the meninges (the protective membranes covering the brain and spinal cord), depends on several factors such as the size, location, growth rate, and symptoms caused by the tumour. Meningiomas are usually benign (non-cancerous), but they can sometimes be malignant or cause significant symptoms due to their location. In this article, leading consultant neurosurgeon Mr Andrew Kay provides a detailed overview of the treatment process.

Observation (Watchful waiting)

In cases where the meningioma is small, slow-growing, and not causing any symptoms, a ‘watch-and-wait’ approach might be taken. This involves regular monitoring with periodic imaging scans, such as MRI or CT, to track the tumour’s growth. Observation is often recommended for older patients, those with minimal symptoms, or patients who cannot undergo surgery due to other medical conditions.

Surgical removal

If the meningioma is large, growing, or causing symptoms like headaches, seizures or neurological deficits, surgery is often the first line of treatment. The goal of surgery is to remove as much of the tumour as possible without damaging the surrounding brain tissue. Surgical approaches may vary depending on the tumour's location:

• Complete removal: If the tumour is in an accessible area, surgeons aim to remove the entire mass.
• Partial removal: In some cases, the entire tumour cannot be safely removed, especially if it's located near critical brain structures. In such situations, a portion of the tumour is left behind, and further treatments like radiation therapy may be considered.

Radiation therapy

Radiation therapy may be recommended for meningiomas that cannot be fully removed by surgery, for those that recur after surgery, or for tumours that show signs of malignancy. There are different types of radiation therapy used in meningioma treatment:

• External beam radiation: This involves directing high-energy radiation at the tumour to shrink or control its growth. It is often used post-surgery to target any remaining tumour cells.
• Stereotactic radiosurgery (SRS): This is a precise form of radiation treatment where focused beams are aimed at the tumour, minimising damage to surrounding tissue. It's often used for small or hard-to-reach tumours and can be an option instead of surgery in certain cases.

Chemotherapy

Although chemotherapy is not commonly used for benign meningiomas, it may be considered in rare cases of malignant or aggressive tumours, especially if they recur after surgery and radiation. Clinical trials are also exploring new drug therapies for certain types of meningiomas.

Hormonal therapy

In some cases, hormone therapy might be explored, as certain meningiomas are hormone-sensitive, particularly in women. However, this is not a standard treatment and is typically only considered in specific cases.

Supportive care and rehabilitation

Patients with meningiomas may experience symptoms such as headaches, seizures or neurological impairments that affect movement, speech, or vision. Supportive care, including medications for seizure control or pain management, is often part of the treatment plan. Rehabilitation therapies, such as physical, occupational or speech therapy, may be necessary to help patients recover function lost due to the tumour or its treatment.

Follow-up care

Long-term follow-up with regular imaging scans is crucial, as meningiomas can recur, particularly if they weren’t completely removed during surgery. Even benign meningiomas require periodic monitoring to ensure they are not growing back.

In summary, the treatment process for meningioma is highly individualised and may involve observation, surgery, radiation, and, in some cases, chemotherapy or supportive care. The chosen approach depends on the tumour’s characteristics and the patient’s overall health.

Are you looking for top meningioma treatment? Arrange a consultation with Mr Kay via his Top Doctors profile.