Meningiomas
Overview
 

Meningiomas are tumors that form in the meninges, a membrane that surrounds the brain and the spinal chord. The meninges, which consists of three layers the dura mater, arachnoid, and the pia mater. On average these tumors a benign with only 10% being malignant. Since the overwhelming majority of these tumors are benign they do not pose an immediate threat until they begin to adhere to other structures and put pressure on the brain. Benign meningiomas grow at a slow rate, thus a patient can have the tumor for a substantial amount of time before symptoms begin to surface. On the other hand, malignant menginomas can grow rapidly or have a spontaneous spurt in growth.

Meningiomas are the second most prevalent kind of tumor of the brain. The majority of patients with meningiomas are middle aged and women are three times more likely to develop this type of tumor than men. There have been some reported cases of meningiomas in children but these are very rare as less than 2% of patients are children.

About 90% of meningiomas occur intracranially, or inside the brain, with remaining 10% occurring in the spinal chord. Almost all menginomas that occur inside the brain happen at one site. Although it is rare, there have been cases of multiple menginomas that occur simultaneously among different parts of the brain and the spinal cord. These tumors are found in various shapes such as solitary masses, dome-shaped, oval, round, and an uncommon form called meningioma-en-plaque is flat and conforms to the shape of the brain and inside the skull.

Symptoms

Due to benign meningioms slow growth rate patients are not aware of the tumor until it is quite large and interferes with other structures. In some cases, a person may go the rest of his or her life without any symptoms or knowing there is a brain tumor. In this instance the tumor is found incidentally when a brain scan is done for something completely unrelated or an autopsy is performed.

When symptoms are prevalent they can vary extensively and depend largely on the where the tumor is located and also the size. Symptoms are often associated with a buildup of pressure on structures that are adjacent to the tumor. Patients with intracranial meningiomas can have headaches, muscle weakness or fatigue, personality changes, confusion, loss of hearing and vision, and can also experience seizures which is the most common symptom. Meninigiomas that are located along the spinal cord can have weakness and pain in the affected region.

Diagnosis

An extensive medical history of the patient is studied along with a complete physical examination looking closely at neurological results. Next an MRI and CT scans are ordered for the patient which will reveal the size and location of the meningiomas. The MRI gives a detailed picture of the tumor, and the CT scan will display a better image of the bone structure to which helps to find out if the tumor has progressed into the bone or if the tumor has calcified.

Treatment

Malignant tumors are surgically removed and benign tumors are typically surgically removed when they are rather large or cause neurologic deficits. When a tumor needs to be removed a minimally invasive procedure is carried out via cameras and instruments that enter the brain through either the nasal cavities or through a small incision made on the scalp or near the spinal cord.

Benign tumors that only cause the patient minor symptoms can be controlled with medications and monitored with regular MRI exams to ensure that it doesn’t grow or spread rapidly.

If the tumor is malignant then radiation is used as a follow up treatment after surgery to ensure that the tumor does not reoccur. If in some cases the tumor cannot be surgically removed then radiation therapy is recommended to combat the tumor and stopping it from growing.

Prognosis

It is difficult to give an overall prognosis for patients with meninigiomas due to so many variations such as malignant and benign, tumors of the brain or of the spinal cord, and also the size of the tumor itself. The prognosis for patients with benign meningiomas is good as long as the tumors do not cause permanent neurological damage. If a tumor needs to be removed it can be done relatively easily and the surgery often has great results. Radiation for those with malignant meningiomas, more often than not, keeps the tumors from coming back.

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