A meningioma is a brain tumor that is benign in most cases and does not cause symptoms at the beginning due to its slow growth. Meningiomas are among the most common brain tumors, accounting for about 15 percent of all tumors inside the skull, and women are more likely to develop meningiomas than men.
What is a meningioma?
Schematic diagram showing the location of a brain tumor in the brain. Click to enlarge. A meningioma is a usually benign (benign) and slow-growing brain tumor that originates from the so-called meninges, the covering cells of the arachnoid membrane of the brain and spinal cord, which are spider tissue membranes that, together with the pia mater, line the cranial cavity below the hard meninges as the soft meninges (leptomeninx). Most often, meningiomas border the hard meninges from the inside and, as they grow, displace the surrounding tissue, which can cause damage to the meninges as well as neurological disorders. A meningioma may have multiple tumor foci (meningeomatosis) as well as diffuse (scattered) growth, although those with more than one tumor focus usually have a genetic condition (neurofibromatosis type 2 or Recklinghausen disease).
Causes
The causes for the development of a meningioma have not yet been fully elucidated. It is considered certain that a meningioma develops when arachnoid cells, or cells of the cobweb, degenerate and proliferate, although the triggers for this degeneration process are unclear. In addition, children who have been exposed to radiation therapy as a result of tumor disease have an increased risk of developing meningiomas, particularly malignant meningiomas. Furthermore, genetic factors are assumed, since in many cases a loss of information on chromosome 22 can be detected in people affected by meningiomas. However, traumatic brain injury or meningioma, as well as other cranial injuries, can be excluded as precipitating factors for meningioma.
Symptoms, complaints, and signs
Meningioma often persists for several years before the first symptoms appear. The first signs of a brain tumor are nonspecific and may occur in different areas of the body. For example, there may be disturbances in smell, vision and speech, fatigue, headache, and paralysis of the limbs. In addition, seizures, failure of the arms and legs, and psychological changes may occur. If the tumor is localized in the spinal canal, there are sensory disturbances, back pain and nerve discomfort. Externally, meningioma can be recognized by weight loss, pale skin and a generally sickly appearance. The meningioma develops very slowly and the brain can adapt well to the tumor, which is why the affected persons themselves usually do not notice any signs of the disease at all. It is often the relatives who notice noticeable symptoms such as personality changes. Older patients then show signs of dementia or depression, while children and adolescents may experience growth disorders. If the tumor is localized in the bony skullcap, this can lead to increased bone growth. The result is an externally visible bump. In some patients, the eyeball also protrudes. This so-called exophthalmos is also associated with pain and severe discomfort. The symptoms increase with the growth of the tumor and regress only slowly after removal of the growth. Long-term damage often remains.
Diagnosis and course
Diagnostic imaging techniques such as a CT (computed tomography) or MRI (magnetic resonance imaging) are primarily used to diagnose meningioma. Here, the tumor is made visible by a contrast medium with which it accumulates. If a tumor with a smooth border in the area of the meninges and the characteristic thickening in the contact area between the tumor and the meninges is detected during these procedures, a meningioma can be assumed. As a rule, a meningioma has a good course, but in rare cases (1.7 percent) it can degenerate into a malignant brain tumor with metastasis. Due to the very slow growth of this type of brain tumor, a meningioma often causes no symptoms at the beginning and is only diagnosed by chance after years.If symptoms such as neurological disorders (sensory disturbances, restriction of vision or speech) occur, surgical intervention becomes necessary. In some cases (13 percent), so-called anaplastic or atypical meningiomas, the prognosis is less favorable.
Complications
In most cases, meningiomas are diagnosed late because they do not cause particular symptoms or complications during the first months and years as they grow. For this reason, early treatment of this disease is usually not possible. Those affected suffer primarily from severe headaches and sensory disturbances. There are also disturbances in sensitivity and paralysis in various regions of the body. Due to the paralyses and movement restrictions, the affected persons may be dependent on the help of other people in their daily lives. Similarly, epileptic seizures and visual disturbances are not uncommon. Patients also suffer from disturbances in thinking and speaking, so that communication with other people is equally impeded by the meningioma. The quality of life is significantly reduced by this tumor. The tumor can be removed by surgery. It cannot be generally predicted whether the symptoms will disappear completely. As a rule, those affected are then also dependent on chemotherapy, during which it is not uncommon for various side effects to occur. Furthermore, the life expectancy of the patient may also be reduced by the meningioma.
When should one go to the doctor?
Diagnosis of meningioma is often difficult because the growth is very slow. Signs and symptoms may thus be mistaken for other medical conditions or written off as normal signs of aging. Headaches that are only temporary can be eliminated, if necessary, by changing the diet or taking higher amounts of water. Conscious avoidance of psychological stress and more sleep can also provide significant relief. The workstation in the office should possibly be optimized, since disproportions between screen orientation and sitting position can also have a negative effect on the head joints, which can lead to headaches. A physiotherapist or osteopath can help here. A visit to the family doctor is advisable in case of persistent headaches that get worse over time. If he or she suspects a meningioma, referral to a neurologist may be necessary, who will then perform examinations followed by imaging tests such as CT or MRI. In some circumstances, a meningioma may require emergency care if there is sudden onset of seizures and changes in vision or memory.
Treatment and therapy
Treatment for meningioma depends on the location, size, and rate of growth of the tumor. Because of the basically benign nature and very slow growth of a meningioma, its development is monitored at the outset during follow-up examinations. If neurological disorders manifest themselves, the meningioma is removed during a surgical procedure. Angiography is used to visualize the meningeal arteries that supply the meningioma, which are embolized (obliterated or occluded) during the procedure to minimize blood loss. Surgical intervention aims to completely remove the meningioma. If complete removal of the tumor is not possible or if a malignant meningioma is present, additional radiation therapy is required following surgery to kill residual tumor cells. In this case, small tumors (maximum three centimeters in diameter) are irradiated once with high-dose gamma rays using a gamma knife or linear accelerator as part of radiosurgery. This form of therapy is also used if the meningioma is in a location unfavorable for surgery or if the general condition of the affected person does not allow such an operation. Chemotherapy is used only in exceptional cases for meningioma because only a few clinical or experimental studies of it exist to date, and its efficacy in meningiomas has not yet been demonstrated.
Outlook and prognosis
Statistically, six out of every 100,000 people will develop a meningioma during their lifetime.A noticeable number of patients are between the ages of 40 and 60 at the time of diagnosis. The risk is higher for women. Looking at the chances of recovery, the picture is mixed. About nine out of ten diseases are benign. If such a tumor can even be completely removed by surgery, a full recovery is likely. If, on the other hand, tumor cells remain, the tumor will grow again. In one out of ten other cases, the meningioma is fast-growing or malignant. This tumor has a comparatively poor prognosis. For one thing, there is an increased risk of regrowth. On the other hand, in the malignant form, metastasis occurs in one in three patients. Almost 80 percent suffer a renewed tumor growth within five years after prognosis. The location of the tumor tissue always plays a role in evaluating the outlook. For example, if it is afflicted on the underside of the brain, it usually cannot be completely removed. Also, with such an unfavorable location, a surgeon can easily damage the brain. This results in permanent, irreparable neurological disorders.
Prevention
Since the precipitating factors for the manifestation and development of meningioma have not yet been clarified, it cannot be prevented. In general, unnecessary radiation (especially in children) and carcinogenic substances such as nicotine or alcohol should be avoided. In addition, a healthy diet and exercise strengthen the body’s defense system and help minimize the risk of cancer and, therefore, the risk of meningioma.
Follow-up
Very often, the diagnosis of a meningioma occurs relatively late, as there are hardly any symptoms or complications during the first years or months of growth. Therefore, it is hardly possible to treat this disease at an early stage. Patients mainly suffer from sensory disturbances and severe headaches, and paralysis may also occur in various parts of the body. As a result, the affected persons may be restricted in their movements and then also require assistance in order to cope with their daily lives. Visual disturbances or epileptic seizures may also occur. Sufferers often also suffer from speech or thought disorders, which can cause problems in communication. Thus, the patient’s quality of life can suffer considerably when a meningioma occurs. The tumor can be removed by surgery, but it cannot be predicted with certainty whether the symptoms will disappear completely as a result. Normally, patients must also undergo chemotherapy, during which a wide variety of side effects can occur. In addition, the life expectancy of those affected by meningioma may be reduced, as the risk of the tumor growing again is relatively high.
Here’s what you can do yourself
Accompanying medical treatment, meningioma patients can resort to some strategies and self-help measures to make their daily lives easier and support the therapy. First, the doctor will recommend rest and sparing. Especially in the first period after surgery, the patient must refrain from strenuous activities. Accompanying this, a balanced diet is recommended, in which dietary fiber is included instead of carbohydrates. Since brain tumors need sugar to grow, sweet foods, certain types of fruit and sugared drinks such as lemonade or cola should also be avoided. Foods such as chickpeas, soybeans and red clover should be included in the diet because of their high biochanin content – a dietary fiber that has a healing effect on tumor cells. In addition to dietary changes, general measures such as regular exercise and avoiding stress are recommended. Patients are also advised to visit a self-help group and exchange information with other patients. In general, it is important to understand the disease, because only in this way can it be overcome in the long term, also mentally. The association Deutsche Hirntumorhilfe e.V. offers further information for those affected.
