Meningioma

Meningiomas usually grow slowly. They may not cause any obvious symptoms and are often found during tests for something else. Tumours that do not cause symptoms may not need any treatment.

As a tumour grows, it can press on nearby areas of the brain. This can cause symptoms because it stops that part of the brain from working normally. Some symptoms can also happen because the tumour causes a build-up of pressure inside the skull. This is called raised intracranial pressure.

Symptoms can depend on the size and position of the tumour. They also depend on how slowly or quickly it grows. Symptoms may develop suddenly, or slowly over months or years.

Symptoms may include:

• headaches
• problems with balance
• weakness in an arm or leg
• change in your eyesight
• changes in speech or swallowing
• changes in personality
• being confused
• seizures (fits)
• sickness (vomiting).

We have more information about possible symptoms of a brain tumour.

Your doctors need to find out as much as possible about the position and size of the tumour. This helps them to plan your treatment.

You will usually have brain scans to find out the exact position and size of the tumour. You may have a brain CT scan first. You also usually have an MRI brain scan.

Having an MRI scan is important as it can give more detailed information. If you are not able to have an MRI scan, your doctor or nurse will discuss this with you.

There are different types of MRI scans. You may need to have more than 1 type to get enough information to make a diagnosis and guide treatment decisions.

Rarely, you may also have an angiogram. This is a test to check the blood vessels in the brain that supply the tumour. If you need this test, your nurse or doctor will explain it in more detail.

Meningiomas can often be diagnosed using only scans. A biopsy is rarely needed.

Depending on the part of the brain that is affected, your doctor may also:

• check your balance and the power and feeling in your arms and legs
• ask you some questions to check your reasoning and memory
• check the movements of your eyes and face
• arrange for you to have blood tests to check your general health and to see how well your kidneys and liver are working.

The main treatments for a meningioma that is growing or causing symptoms are surgery and radiotherapy. You may have a combination of treatments. Your treatment depends on:

• the size and position of the tumour
• its grade
• your symptoms.

A team of specialists will plan your treatment. Your specialist doctor and nurse will explain the aims of your treatment and what it involves. They will talk to you about the benefits and disadvantages of different treatment types. They will also explain the risks and side effects.

You may be given a choice of treatment options. You will have time to talk about this with your hospital team before you make any treatment decisions.

You will need to give permission (consent) for the hospital staff to give you the treatment. Ask any questions about anything you do not understand or feel worried about. Tell your specialist if you need more information or more time to decide on a treatment. 

Active monitoring means regularly checking the tumour to find out whether it is growing. Most meningiomas are very slow-growing.

Your doctor may suggest delaying treatment until it is needed if:

• the tumour is not growing
• it is growing very slowly and not causing you problems.

This is because treatment can cause side effects. Some of these may be permanent. Your doctor may suggest treatment, but only if the benefits outweigh the risk of side effects. In some people the tumour grows so slowly that treatment is never needed.

Instead of starting treatment, you may meet your specialist doctor regularly and have scans to check for changes in the size of the tumour. They will also monitor your symptoms carefully. This can help your doctor know when to recommend treatment.

Talk to your specialist doctor or specialist nurse if you are worried about any symptoms. They will explain the benefits and risks of active monitoring.

If you need treatment, you are likely to have surgery to remove the tumour. Often this is the only treatment that is needed.

The aim is usually to remove all of the tumour, but sometimes this may not be possible. How much surgery you have may depend on the location of the tumour and how easily it can be reached. It also depends on whether it is close to important structures such as major blood vessels.

In these cases, you usually have as much removed as possible. You may be offered radiotherapy to the area afterwards to treat the remaining tumour. Or it can be managed with active monitoring or surveillance.

If the position of the tumour, or your general health means you are not able to have surgery, you may be offered radiotherapy instead.

Your surgeon and specialist nurse will explain about the surgery and what to expect.

Radiotherapy uses high-energy rays to destroy the tumour cells and control the tumour.

You may have radiotherapy:

• after surgery, if the tumour cannot be completely removed and if the remaining tumour may start to cause problems in the future
• after surgery for grade 2 meningioma, if it was not possible to remove all the tumour
• after surgery for a grade 3 meningioma to reduce the chance of it coming back
• as your main treatment, if surgery is not possible.

Radiotherapy can cause different side effects, including fatigue. We have more information about the side effects of radiotherapy and how to manage them.

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy tumour cells. Meningiomas do not respond well to chemotherapy, so it is very rarely used. Chemotherapy can cause side effects. Side effects will depend on the chemotherapy used. You doctor or nurse can explain more about this.

Your specialist doctor or specialist nurse will explain your treatment and possible side effects. Most side effects are short-term and will improve gradually when the treatment is over. Some treatments can cause side effects that do not get better. These are called long-term effects. You may also get side effects that may start months or years later. These are called late effects.

We have more information about coping:

• before and after surgery
• with side effects of radiotherapy.

You may need treatment for the symptoms of a meningioma before you have any treatment for the tumour. You may also need your symptoms managed during your main treatment or for a while after it has finished.

You may have the following treatments:

• Drugs to help reduce the risk of seizures. These are called anti-convulsants or anti-epileptic drugs (AEDs).
• steroids to reduce swelling around the tumour.
• Rarely, surgery to place a long, thin tube called a shunt. This may be needed if there is a blockage stopping the fluid from the brain from draining to another area of the body. This is called hydrocephalus. Allowing the fluid to drain helps reduce pressure inside the skull.

Clinical trials are a type of medical research involving people. They are important because they show which treatments are most effective and safe. This helps healthcare teams plan the best treatment for the people they care for.

Trials may test how effective a new treatment is compared to the current treatment used. Or they may get information about the safety and side effects of treatments.

They will give you information about the clinical trial so that you understand what it means to take part. If you decide not to take part in a trial, your specialist doctor and nurse will respect your decision. You do not have to give a reason for not taking part. Your decision will not change your care. Your doctor will give you the standard treatment for the type of tumour you have.

Clinical trials also research other areas. These include diagnosis and managing side effects or symptoms. As these tumours are rare, there may not always be a relevant clinical trial happening. If there is, your doctor or nurse may ask you to think about taking part.

We have more information about clinical trials.