Treatment Options for Meningioma

May 12, 2016 Brigham and Women's Hospital

Dr. Ian F. Dunn

Dr. Ian F. Dunn, BWH Department of Neurosurgery

In observation of Brain Tumor Awareness Month, today’s blog post was written by Ian Dunn, MD, Department of Neurosurgery, Brigham and Women’s Hospital (BWH).

A meningioma is a type of tumor that develops from the meninges, the membrane that surrounds the brain and spinal cord. About 85 percent of meningiomas are categorized as benign tumors. Because most benign meningiomas grow slowly, they may reach a relatively large size before causing symptoms, such as headaches, blurred vision, seizures, numbness, weakness in the arms or legs, or speech difficulty.

There are generally three treatment options for meningiomas: observation, surgery, and radiation. The BWH Department of Neurosurgery is also conducting clinical trials to identify new therapies.

Observation

Meningiomas that are smaller in size and are not causing symptoms may be observed by your physician. We commonly perform periodic CT or MRI scans at intervals of six to 12 months and consider medical intervention if growth is observed over time or if symptoms develop.

Surgery

Surgery remains the primary treatment for meningiomas. The goal of surgery is to remove all of the meningioma and the membranes from which it originates. Occasionally, surrounding bone is involved as well. Because meningiomas arise from the lining around the brain, understanding the normal brain structures around them is an important consideration before and during surgery.

The complexity of surgery to remove a meningioma is often determined by where the tumor is located. Meningiomas located at the surface of the brain (convexity) are more easily accessed than those at the skull base, those that involve the blood vessels in the brain (sagittal sinus or cavernous sinus), or meningiomas in the optic nerve sheath. BWH neurosurgeons have particular expertise in operating on meningiomas in any location.

Recovery can vary according to the length and type of your surgery. Usually, patients are observed in the neurosurgery intensive care unit (ICU) overnight. The next day, they can expect to be transferred to a regular hospital floor, where they will be walking, eating, and drinking. A common hospital stay is between two to five days. Occasionally, patients may need to recover at a rehabilitation facility prior to returning home.

Once home, patients can expect to be walking and moving around, but they may be more tired than usual in the first seven to 10 days after surgery. Patients may resume normal activities, including driving, as soon as they feel strong enough. Patients should plan on being absent from work for four to eight weeks, depending on the type of surgery.

Radiotherapy

Radiation may have a role, in combination with surgery, to more fully treat patients with aggressive forms of meningioma. Newer ways of delivering radiation, such as stereotactic radiosurgery, stereotactic radiotherapy, or intensity-modulated radiotherapy, deliver more focused radiation, minimizing radiation exposure to the normal brain tissue surrounding the tumor. Radiation may be given in one large dose (stereotactic radiosurgery) or in multiple small doses (stereotactic radiotherapy).

Meningioma Research

There are no approved drugs for meningioma, although clinical research may lead to drug treatments for patients with recurrent meningiomas.

Currently, researchers at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) are studying the genetic basis underlying the growth of meningiomas. By studying our patients’ tumors, we and others have identified important new genes in meningioma growth. Two of these genes have formed the basis of a clinical trial for patients with specific genetic changes in their tumors.

In patients with more aggressive meningiomas, researchers at DF/BWCC also have started a new clinical trial in which they are priming the immune system to kill tumor cells. This has shown great promise in other brain tumor types.

Choosing the Best Treatment Option for Menigioma

Patients should fully explore their options. You may find that several doctors will suggest the same treatment options, or you may be faced with different suggestions from which to choose. Every treatment has its own set of risks and benefits, and the treatment has to be tailored to the type and location of each individual meningioma. Other factors that will affect your treatment choice are your age, overall state of health, and which medical center you turn to for treatment.

Don’t hesitate to consult your doctor if you need more information about your diagnosis, treatment choices, or anything to do with your meningioma or related health issues.

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