November 2015
Ask the Expert Information Sheet
About Meningiomas
By: Natalia Kurtycz and Michael S. Taccone, MD
Authors:
Ms. Natalia Kurtycz is a
final year Health Sciences
student at the University
of Ottawa with a strong
interest in medicine. She
is also a volunteer at the
Cancer Centre at the Ottawa
Hospital’s General Campus.
In her spare time, Natalia
assists the members of the
Division of Neurosurgery
at the University of Ottawa
with brain tumour research
projects that aim to improve
the lives of those affected by
the disease.
Dr. Michael S. Taccone is a
Neurosurgery Resident at
the University of Ottawa/
The Ottawa Hospital who
has a special interest in
neuro-oncology. Dr. Taccone
is actively involved in both
basic science and clinical
research aimed at improving
treatments, experiences and
quality of life of patients and
families affected by brain
tumours. Dr. Taccone also
serves as a member of the
Professional Advisory Group
of Brain Tumour Foundation
of Canada.
What is a meningioma?
Meningiomas are a category of generally non-malignant tumours arising from
the meninges of the brain. Meninges are the thin layers of protective tissue
surrounding the brain and spinal cord. The meninges divide into 3 layers: the
pia mater, the arachnoid mater, and the dura mater. The dura mater is the
outermost layer. Meningiomas arise from the middle layer: the arachnoid mater.
These tumours are therefore found outside of the brain (but inside the skull).
What are the signs and symptoms of meningiomas?
Most patients with meningiomas are asymptomatic and usually come to clinical
attention incidentally. When symptoms are present they are dependent on
tumour location and size and may include headaches, behavioural changes,
cognitive problems, visual disturbances, headaches, morning nausea, and
vomiting. In some patients, seizures can develop as well.
Who gets meningiomas?
Meningiomas are the most common primary brain tumour in North America
and often arise in mid to late adulthood. Risk increases with age and peaks at
60 to 70 years of age. Rare cases may arise in childhood. The overall prevalence
is higher among women compared to men in all types of meningioma with a
ratio of 2.5:1.
Although the vast majority (95%) of cases are sporadic, in 5% of cases,
meningiomas arise in patients with an inherited genetic condition called
neurofibromatosis type 2 which can also be seen in pediatric cases.
The only known environmental risk factor that increases the likelihood of
developing a meningioma is exposure to cranial ionizing radiation (cell phones
do not emit ionizing radiation).
Are there different types of meningiomas?
Meningiomas are classified by the WHO grading system from Grade I-III based
on their appearance under the microscope. Grade I meningiomas are lowgrade and do not possess any malignant characteristics. Grade II meningiomas
are called atypical and do possess only some malignant features. Grade III
meningiomas are called anaplastic, these are frankly malignant, are considered
a cancer, and require radiation and chemotherapy for treatment. In North
America, 94% of meningiomas diagnosed are WHO grade I.
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References:
Landriel, F and Black, P.
Chapter 36: Meningiomas
in Principles of Neurological
Surgery 3rd Ed.
(Ellenbogen, R., Abdulrauf,
S. & Sekhar, L. eds), Elsevier
Saunders: Philadelphia,
2012.
It is important to note that within each grade category different subtypes of
meningioma exist according to their unique appearances under the microscope.
However, it is their grade and not their unique subtype that typically dictates
the recommended treatment and clinical management.
The most common grade I meningioma subtypes are meningothelial,
fibroblastic, and transitional. Amongst grade II meningiomas, clear cell and
chordoid are most prevalent. The most frequent grade III meningiomas are
papillary and rhabdoid.
Al-Mefty, O., Abdulrauf, S.
and Haddad, G. Chapter
131: Meningiomas in
Youman’s Neurological
Surgery, Sixth Edition, Vol
2: Oncology, (Brem, H,
Sawaya, R and Chiocca EA,
eds.), Elsevier Saunders:
Philadelphia, 2011.
What is the treatment for meningiomas?
Meningiomas are typically diagnosed and followed by a neurosurgeon through
MRI or CT scan. Unlike other brain tumours, meningiomas have a fairly
characteristic appearance on MRI and therefore usually do not require a biopsy
for confirmation of the diagnosis.
The typical treatment for meningioma is surgical resection. In cases where
the tumour cannot be fully removed, radiation therapy such as stereotactic
radiosurgery (a form of precision radiation) may be used in addition to surgical
procedures. In cases of grade III meningioma, chemotherapy may also be used
as an adjunct to treatment.
Ildan, F., Erman, R., et al.
Predicting the Probability
of Meningioma Recurrence
in the Preoperative and
Early Postoperative Period.
Skull Base (2007). Volume
17(3). pp. 158-169. Found
at: http://www.ncbi.nlm.
nih.gov/pmc/articles/
PMC1888737/
Brain Tumour Foundation
of Canada Information
Sheets are provided as
an informational and
educational tool and are
not intended to replace
the advice or instruction of
a professional healthcare
practitioner, or to substitute
for medical care. We urge
you to seek specific medical
advice on individual matters
of concern.
Do all meningiomas require surgery?
No. Although surgery is the treatment of choice for these tumours in patients
who are symptomatic, surgery may not be necessary or recommended for
certain patients.
As an example, no treatment or radiation therapy may be best for patients with:
• Small, slowly growing tumours with minimal or no symptoms
• Surgically inaccessible tumours
What is the prognosis for meningiomas?
After surgery recurrence rates vary between 10-32% in the next decade of life.
Factors associated with an increased likelihood of recurrence include:
• Larger tumour size and attachment to neighbouring normal structures
• Higher WHO tumour grade
• Less than complete tumour removal
In patients who are symptomatic prior to surgery, symptoms may resolve
immediately after surgery or after a series of weeks. In some patients however,
symptoms may only improve but not fully disappear. A discussion should be
had with your treating neurosurgeon to discuss the likely risks and benefits of
surgery for your unique case.
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