Meningioma is one of the most common human neoplasms of the nervous system. In the vast majority of cases, the lesion is benign, but there are also cases where the meningioma is malignant. Some meningioma patients are advised to undergo surgery, while for others, only ... regular observation is implemented. So what determines the management of a patient who has developed meningioma?
Table of contents:
- Causes of meningioma
- Symptoms of meningioma
- Diagnosis of meningioma
- Treatment of meningioma
- Prognosis of patients with meningioma
A meningioma is a neoplastic lesion that originates in the meninges(brain or spinal cord) that cover the central nervous system. This neoplasm can develop either in the cerebral region or in the vicinity of the spinal cord. The lesion is most often, as much as 90% of cases, benign in nature. This situation is most favourable, as meningiomas, according to statistics, account for up to 30% of all central nervous system tumours, thus being one of the most common lesions of this type.
Theoretically, a m eningioma can develop in a person of any age (even in a child, although this situation is rather rare). In practice, most cases of meningiomas occur in people between 30 and 70 years of age. Tumours are more common in women - it is estimated that these intracranial lesions are twice as common in women as in men, while meningiomas developing around the spinal cord are up to six times more common in women.
Causes of meningioma
The aetiology of meningiomas has not yet been clearly established - it is not entirely clear what leads to the development of these tumours. However, it has already been noted what factors may increase the risk of meningioma. First and foremost, attention is drawn here to a history of radiotherapy: in particular, radiotherapy carried out in the head increases the risk of meningioma. It is worth mentioning here, however, that there is usually a time lag of many years between such treatment and the eventual occurrence of a tumour.
The second known risk factor for the development of meningiomas is neurofibromatosis type 2.
As meningiomas occur far more frequently in women, attempts have been made to find a link between the development of these lesions and female sex hormones. Receptors for progesterone have already been detected on meningeal cells - it is possible that this hormone may therefore favour the development of these cells and that this is why the described lesions appear more frequently in women than in men.
Symptoms of meningioma
Two factors primarily determine what the symptoms of a meningioma may be: its size and in which area the lesion is located. In the case of small tumours, patients usually do not experience any symptoms and may become aware of the presence of a meningioma entirely by chance (e.g. during head imaging for some other reason).
However, thesymptoms of m eningioma can also include problems that are encountered with other types of brain tumours. Examples of complaints that may occur in people with meningioma include:
- headaches,
- seizures,
- paralysis or muscle weakness,
- visual disturbances (e.g. in the form of double vision),
- changes in behaviour,
- cranial nerve palsies,
- sensory disturbances,
- speech disorders.
Meningioma, photo: shutterstock
The greatest risk associated with meningioma occurs when patients develop an increase in intracranial pressure. This condition is characterised by, among other things, persistent, intense headaches and requires the patient to be urgently transported to hospital.
Diagnosis of meningioma
Meningioma is not infrequently, as already mentioned, detected completely by chance. However, when a patient presents to the doctor with any of the above-mentioned symptoms, it is necessary to carry out a full diagnostic procedure - the symptoms described may occur in the course of a benign meningioma, but also in the case of an extremely malignant glioma multiforme, therefore making a proper diagnosis is absolutely crucial. Initially, a neurological examination is carried out: the abnormalities found during this examination allow us to assume in which part of the nervous system the pathological lesion is located. This is followed by imaging examinations, such as computed tomography or magnetic resonance imaging (MRI), which can visualise the lesion as a meningioma.
After imaging examinations, the assumption of meningioma can be made with a high degree of probability, but a definitive diagnosis can only be made after histopathological examination. Only histopathological examination can determine whether a patient's lesion is indeed a meningioma and, in addition, microscopic examination can distinguish between benign and malignant lesions. All of the above-mentioned findings are extremely important for the subsequent selection of treatment and determination of the patient's prognosis - for this reason, it is not uncommon for patients with suspected meningioma to undergo a biopsy, during which a fragment of the lesion is taken and later submitted for histopathological examination.
Meningioma treatment
The therapeutic management of patients with meningioma depends both on the size of the lesion and whether the patient develops any complaints. For those patients whose meningioma is small in size and who do not develop any symptoms in connection with the tumour, only observation of the lesion may be recommended. In this situation, regular follow-up examinations are essential to detect possible enlargement of the lesion and, if necessary, initiate treatment for the patient.
If, on the other hand, the patient has a large meningioma, the tumour is in an unfavourable location or is causing severe pain, the patient is usually offered appropriate treatment. This is usually based on surgical removal of the lesion. Sometimes, however, the tumour is located in a place from which surgical resection would be difficult, and it is also possible that the lesion cannot be completely removed during surgery. In such cases, radiotherapy may be used as a treatment option.
One might think that one method of cancer treatment - chemotherapy - has been omitted here. This has been done deliberately, as meningiomas generally respond poorly to chemotherapy and chemotherapy is therefore unlikely to be used in patients with this cancer.
Prognosis of patients with meningioma
In general, the prognosis of most patients with benign meningiomas is considered to be good - complete surgical resection of the tumour usually results in resolution of any associated complaints. However, the problem is that meningiomas have a tendency to recur - after resection of the lesion, recurrence is eventually seen in 5 to up to 20% of all patients operated on.
