MENINGIOMA

Natural History and Treatment Options

Background

Meningioma is a type of non-cancerous brain tumor that originates from the protective membrane surrounding the brain and spinal cord. It's important to note that the majority of meningiomas (around 90%) are considered benign, meaning they grow slowly and are not cancerous. However, it's essential to be aware that certain tumors in challenging locations can compress and impact the brain, leading to significant disability and potentially life-threatening symptoms.

Meningiomas are more commonly found in females and their incidence tends to increase with age. However, rare cases of malignant meningiomas, which are cancerous, are more frequently observed in men.

In many cases, meningiomas do not cause noticeable symptoms and are often discovered incidentally during radiological investigations conducted for unrelated medical conditions. The symptoms experienced by patients largely depend on the location of the meningioma and the specific brain structures affected. Some of the common symptoms associated with meningiomas include headaches, blurred or double vision, difficulties with speech, weakness in limbs, and in some instances, seizures.

If you experience any of these symptoms or have concerns about your brain health, it's important to consult with your healthcare provider. They can conduct a thorough evaluation, including imaging scans and other diagnostic tests, to determine the presence and characteristics of any meningiomas or other potential brain conditions.

Remember, early detection and appropriate medical management play a crucial role in ensuring the best possible outcome. Your healthcare provider will consider various factors including tumor location, size, and your overall health profile when developing a personalized treatment plan tailored to your specific needs.

Natural History

The natural course of untreated meningioma remains uncertain, posing a challenge in patient management. Previously, neurological symptoms were prevalent among patients with large tumors exerting mass effect. However, the accessibility of advanced neuroimaging has resulted in the identification of smaller incidental lesions, creating a dilemma when deciding on treatment options for asymptomatic individuals. A comprehensive understanding of the natural history of meningioma is pivotal, as it serves as the cornerstone for informed treatment decisions.

Size

When it comes to meningiomas, the size of the tumor plays a crucial role in determining the appropriate treatment approach. Larger tumors have a higher likelihood of causing symptoms, which may require early surgical intervention. Extensive analysis of published studies has shown a correlation between the initial tumor size and its subsequent growth, which directly impacts treatment recommendations.

In general, meningiomas that exceed 4 centimetres (cm) in size are more likely to cause neurological symptoms over time. These symptoms can include headaches, vision problems, speech difficulties, weakness in limbs, or even seizures. It's important to be aware of these potential symptoms and consult with your healthcare provider if you experience any concerning changes.

On the other hand, if a meningioma measures less than 3 cm and is asymptomatic, it may be suitable for close monitoring through regular radiological surveillance. Your healthcare provider will conduct periodic imaging scans to track the tumour's growth and assess any potential changes. This approach allows for ongoing evaluation while minimizing intervention unless necessary.

Understanding the relationship between meningioma size and treatment decisions is essential for effective patient care and management. Your healthcare provider will consider various factors, including the size, location, and characteristics of your specific tumor, along with your individual health profile, to determine the most appropriate course of action.

By staying informed about the impact of tumor size on treatment decisions, you can actively participate in your healthcare journey and make informed choices in collaboration with your healthcare provider. Regular follow-up appointments and open communication will ensure that you receive the best possible care tailored to your unique needs.

Growth rate and tumor doubling time

When it comes to meningiomas, it's important to know that studies have consistently shown that these tumors tend to grow slowly over time. These studies have primarily focused on patients who had incidental tumors, which means the tumors were discovered by chance and not due to specific symptoms. Many of these patients remained without any symptoms throughout the follow-up period.

According to the latest scientific literature, meningiomas have an annual growth rate that ranges from 0.7 to 4 millimetres per year. Additionally, volumetric measures have indicated increases of 3.6% to 20.4% per year. To put it in perspective, this means that a meningioma can potentially double in size every 9 to 10 years.

However, it's crucial to understand that these findings are not without limitations. The natural history studies conducted in this area have some inherent biases. They often focus on older patients who were under observation for relatively short periods of time. These factors can influence the generalizability of the results.

It's important to consult with your healthcare professional regarding the specific characteristics of your meningioma and its potential growth rate. They will consider a range of factors such as tumor size, location, and your individual health profile to provide you with the most accurate information and recommendations for your case.

By staying informed about the natural progression of meningiomas, you can better understand your condition and make informed decisions about your healthcare.

Risk Factors that predict tumor growth

It is important to understand that several factors have been identified to be associated with a higher tendency for tumor growth. These factors include:

Tumor Size: Larger tumor size at the time of diagnosis, typically exceeding 25mm, has been linked to a greater likelihood of growth.
Patient Age: Younger patients, those under the age of 60, may experience more pronounced tumor growth.
Brain Swelling: The presence of brain swelling around the meningioma can contribute to its growth.
Location within the Skull: Certain locations within the skull, such as the "sphenoid ridge," are more prone to meningioma growth.
Tumor Characteristics on MRI: Specific tumor characteristics observed on MRI scans, such as the presence of intra-tumoural T2 hyperintensity, can also indicate a higher potential for growth.

Understanding these factors can help guide treatment decisions and ongoing monitoring of meningioma. We are here to provide you with the necessary information and support throughout your journey.

Treatment Options

Welcome to our patient information guide on the management of meningiomas. The treatment approach for meningiomas depends on various factors, including their natural history, growth rate, and associated risks. In general, there are three main treatment options to consider: observation, radiotherapy, or surgery. The choice of management should take into account the tumor size, location, presence of brain swelling, patient's age, and any existing medical conditions.

Surgical Excision: Meningiomas larger than 3cm in size are likely to become symptomatic as they grow. Therefore, surgical excision is usually recommended for these tumors.
High Growth Rate: Meningiomas that demonstrate a significant growth rate (≥2mm/year) on serial imaging, especially in younger patients in good health, should be considered for surgical excision.
Symptomatic Meningiomas: If a meningioma causes symptoms at any point during the follow-up period, surgical intervention is usually recommended.
Conservative Approach for Elderly Patients: Meningiomas in elderly patients often have a slower growth pattern, and the increased risks associated with surgery may require a more conservative approach.
Observation for Younger Patients: Asymptomatic meningiomas smaller than 3cm in younger patients can be observed through regular radiological surveillance. However, consideration should also be given to the potential for higher-grade meningiomas, where delaying intervention may result in higher operative risks and long-term consequences.
Postoperative Radiotherapy: Patients whose meningioma has not been completely removed during surgery or those with more aggressive subtypes (WHO grades II or III) may be recommended for postoperative radiotherapy.

Our team is here to provide you with personalized guidance and support throughout your meningioma management journey. We will consider your unique circumstances to determine the most appropriate treatment strategy.

Some useful references

Hashimoto N, Rabo CS, Okita Y, Kinoshita M, Kagawa N, Fujimoto Y, et al. Slower growth of skull base meningiomas compared to non-skull base meningiomas based on volumetric and biological studies. J Neurosurg 116(3): 574-80, 2012.
Lee EJ, Park JH, Park ES, Kim JH. “Wait and see” strategies for newly diagnosed intracranial meningiomas based on the risk of future observation failure. World Neurosurg 107:604-11, 2017.
Oya S, Kim SH, Sade B, Lee JH. The natural history of intracranial meningiomas. J Neurosurg 114(5):1250-6, 2011.
Nakamura M, Roser F, Michel J, Jacobs C, Samii M. The natural history of incidental meningiomas. Neurosurgery 53(1): 62-70, 2003
Yano S, Kuratsu J, Kumamoto Brain Tumor Research Group. Indications for surgery in patients with asymptomatic meningiomas based on an extensive experience. J Neurosurg 105:538-543, 2006.
Alvernia JE, Dang ND, Sindou MP. Convexity meningiomas: study of recurrence factors with special emphasis on the cleavage plane in a series of 100 consecutive patients. J Neurosurg. 115(3):491-8, 2011.
Hasseleid BF, Meling TR, Ronning P, Scheie D, Helseth E. Surgery for convexity meningioma: Simpson grade I resection as the goal. J Neurosurg 117(6):999-1006, 2012.
Morokoff AP, Zauberman J, Black PM. Surgery for convexity meningiomas. Neurosurgery 63(3):427-33, 2008.
Kaur G, Savegh ET, Larson A, Bloch O, Madden M, Sun MZ, et al. Adjuvant radiotherapy for atypical and malignant meningiomas: a systematic review. Neuro Oncol 16(5):628-36, 2014.