[4 min read]
In this article:
- Meningiomas are tumors that occur in the lining of the brain or spinal cord.
- These tumors are generally benign, and can be managed with surgery.
- They are often discovered in the course of emergency treatment, such as during a scan associated with an ER visit.
- Read on to learn more from a Providence Swedish neurosurgeon about the symptoms, diagnosis and treatment of these tumors.
According to the American Cancer Society, in 2023, more than 25,000 people were diagnosed with malignant tumors of the brain or spinal cord. Unlike cancers that begin in other parts of the body, tumors that start in the brain and spinal cord — called primary brain or spinal cord tumors — rarely spread to other organs. (Tumors that start in other areas of the body and spread to the brain or spinal cord are called secondary or metastatic brain or spinal cord tumors.)
The most common type of brain and spinal cord tumors are meningiomas, which account for some 30 percent of all tumors. These tumors take their name from where they originate — the meninges, which line the brain and spinal cord. The greatest challenge to treatment for most patients with meningioma is the location of the tumor and what structures around the brain or spinal cord is in proximity.
To learn more about meningiomas, we spoke to Miri Kim, M.D. PhD, a Providence Swedish neurosurgeon, who discussed with us the implications of these tumors, how they’re treated and how Providence Swedish experts are advancing treatment and care for patients with meningiomas.
What is a meningioma?
They are tumors that grow in the lining of our brain and spinal cord. They are generally benign and slow growing, but there is a small number that can be more aggressive, and we call these atypical meningiomas. Atypical or anaplastic meningiomas are generally classified as grade 2 or 3 meningiomas.
Meningiomas are most commonly grade 1 tumors. They are generally benign, are often found incidentally, and can be managed with surgery. As they are generally slow growing, they can be observed over time. Despite the benign nature of most of these tumors, sometimes the location of the tumor may make complete surgical resection difficult. Grade 2 and 3 meningiomas are much less common and have more aggressive features that may require additional treatments in addition to surgery.
How do they occur? Is there a genetic component?
We do not know what causes meningiomas to develop, however we know that meningiomas may have certain mutations involved in the suppression of tumors. The majority of meningiomas are spontaneous, but there can be some genetic components to the formation of meningiomas. Oftentimes, people don’t realize that they have a meningioma and may live with an undiagnosed meningioma for a long time. They may go to the emergency room after a fall or bump to their head and get a CT scan or MRI and learn that they have a meningioma. Sometimes they are symptomatic, and symptoms will depend on where the tumor is located are and what part of the brain, nerves, or blood vessels they are affecting. They are more common in women — specifically in middle age and older — than in men.
What are some symptoms?
Meningiomas can form anywhere along the covering of the brain. They can be difficult to diagnose because of their slow growing nature and variability on where they may develop. They can compress different structures in the brain, and oftentimes, it can tell us the symptoms that you'll have. For example, if a patient has a meningioma that's very close to the optic nerve (the eye nerve) then they might present with visual problems. If they have a meningioma that's pressing on the area of the brain associated with the motor part of the body, a patient might have some weakness or notice that they have difficulty with balance or certain movements. Other times, people will just have headaches. Sometimes if the meningioma gets to be very big and it starts to irritate the brain, then a patient might present with a seizure.
How are they managed?
Because meningiomas are generally slow growing, finding out you have a meningioma does not always mean there is a rush to have surgery. If the tumor is small, and you do not have any symptoms from the tumor, we can observe the tumor over time. Surgery is the usual choice for removing tumors if they are symptomatic or causing injury to the nearby brain tissues or demonstrating that it is growing at a rapid rate. Radiation may also be used for the management of meningiomas, and often may come in as part of treatment if the tumor could not be removed completely during surgery.
Can a patient have an inoperable meningioma?
The word inoperable is sometimes misleading. There are different risks associated with meningiomas, their location, and with surgery. For example, we can do a surgery which can remove the whole tumor, but there may be instances where the tumor is in an area that is difficult to access or near important structures. In those cases, we debulk as much as is safe and reduce the size of the tumor so that it is not pressing on critical structures as much as it was before.
Everybody's surgery is different based on the anatomy and the location of the tumor. In the operating room, we have many tools available to us to help us plan the incision, the approach, and see the tumor better so that we can provide the best possible outcomes.
Are chemotherapy and radiation involved in treating meningioma?
The primary method of treatment is surgery. Depending on that outcome, patients may undergo radiation to target any residual tumor to help keep them at bay. Radiation may also be an option for individuals who are too sick to undergo open surgery. Currently, there are no excellent chemotherapy option for meningiomas, but there are clinical trials looking at some agents that may be useful to treat meningiomas. They can be found on the Swedish website.
Are there post-surgical complications or any side effects?
After any brain surgery, patients will experience post operative pain, and have risks of bleeding and infection. Depending on the location of the tumor and the amount of swelling and irritation around the tumor, patients may experience changes to their nerve functions such as vision and eye movements, or even facial movements and swallowing, or if their brain areas are involved, there may be weakness or language difficulties. If there is some swelling or irritation, you might require some steroids after surgery. Other patients may need seizure medications post operatively as well. We all have to remind ourselves that it takes time to recover from brain surgery, and that we should be patient with recovery.
Learn more and find a physician or advanced practice clinician (APC)
Our experts at the Swedish Neuroscience Institute offer comprehensive, progressive diagnosis and treatment for a wide range of spine, brain and central nervous system conditions. Telehealth options are available.
Whether you require an in-person visit or want to consult a doctor virtually, you have options. Contact Swedish Primary Care to schedule an appointment with a primary care provider. You can also connect virtually with your provider to review your symptoms, provide instruction and follow up as needed. And with Swedish ExpressCare Virtual you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections and more. You can use our provider directory to find a specialist or primary care physician near you.
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This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
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