A protective layer of tissue at the surface of the brain and spinal cord called meninges, a membrane that covers the brain and spinal cord. Tumours arising from this protective covering are called meningiomas.
Meningioma tumours are generally classified as benign. The majority of these tumours are, by nature, very slow-growing. Yet, there is a small percentage that can be aggressive in their growth behaviour. They need to reach a significant size before they cause any signs or symptoms. They may also cause symptoms if they arise close to very eloquent parts of the brain or very close to cranial or spinal nerves.
Meningioma tumours can present with symptoms that include:
The signs and symptoms are a reflection of the location, size and function of the underlying neural tissue.
Meningiomas is a central nervous system disorder. The real cause of meningioma is not known at present. According to the doctors, there is something that produces changes in some cells of meninges. This results in uncontrolled multiplication of these cells which leads to the tumour in the meninges.
The other causes may include inherited genes and hormones. This occurs more commonly in women. Sometimes meningioma can be caused by exposure to radiation but there are still many factors that are mainly unidentified. Meningiomas are not associated with cell phone usage as there is no evidence, presently, to support such a claim.
The risk associated with the meningiomas are:
The definitive diagnosis for such tumours is with an MRI scan. Contrast agents enhances the clarity of images and assists with diagnosing meningiomas.
A CT scan can also provide valuable information in diagnosing meningioma tumours. The scan can detect the extent to which the tumour is covering the bone. It can reveal the changes that the meningioma has caused in the surrounding bone.
The location, size and symptoms of the meningiomas dictate the course of treatment.
As the majority of these tumours are benign, grow slowly and present no symptoms, it may be an option to monitor these tumours with sequential scans.
When these tumours change and need further medical attention, surgery is the definitive treatment. The neurosurgeon uses computer-assisted technology and microsurgical techniques to remove the tumour. These techniques minimise any damage to the normal brain.
In a small percentage of patients, the tumours are located at critical locations. In these cases, surgical treatment has high risks and the chance of poor outcome. So, another option is to consider radio surgical treatment.
After the surgery, the patient has to stay in the hospital for at least few days to weeks. The hospital stay would, however, depend on the location and size of the tumour. The doctor will monitor the condition of the patient during the stay to confirm whether the patient is comfortable or not. In the case where the patient has discomfort, the doctor will prescribe medication to provide relief.
If the surgical procedure is minimal then the duration of recovery is less. This is the case for endoscopic endonasal or spinal surgery. During the stay, the doctor also monitors the function of the brain and spinal cord. This is to confirm whether they are functioning properly or not after the surgery.
Doctors prescribe rehabilitation for those patients who have undergone meningiomas surgery. The therapy continues for several weeks and helps the patient to recover quickly and resume their daily activities.
Related to the treatment of grade II-III meningiomas, a clinical trial was initiated in October 2017. The study involves checking the efficacy of Dual mTORC1/mTORC2 Inhibitor Vistusertib (AZD2014) in the patient. This was restricted to patients who experienced a reoccurrence of meningiomas after the surgery or radiation treatment. AZD2014 is regarded as one of the potent drugs that can treat many types of tumour alone or in combination with other medication with minimal side effects.
Another clinical trial started in March 2016 involves the use of drug Nivolumab in treating the patient with recurrent high-grade meningiomas. The safety and efficacy of the drug are evaluated in the study. Nivolumab can be used alone or in combination to halt the increasing tumour. This treatment enhances the body’s immune system.
Meningiomas occurring in one location are not known to spread to another location. There is a chance of recurrence in patients who have received surgical treatment to remove a tumour.
There are small subsets of patients who can have multiple meningiomas. This generally occurs in patients who have related genetic abnormalities. Or in patients who have had radiation exposure to their whole brain in the past.
Surgery is the definitive treatment option, depending on the location, size and rate of growth. Radiosurgery is another treatment option when the tumour is located around vital structures. Other treatment options include monitoring with sequential MRI scans.
At present there is no conclusive evidence to support this theory.
Neuroaxis recommends close surveillance of patients who have had surgically treated meningiomas. This is due to a small chance of recurrence. Sequential MRI scans over the medium to long terms is the recommended course of action.