Meningioma is one of the most common types of brain tumors, and there are several treatment options depending on your specific case. Age, overall health, symptoms, size of the tumor, and location of the tumor are all factors that will determine the best course of action. Surgery is one route that your physician may recommend, but is not warranted in every case. 

Meningioma surgery

The goal of meningioma surgery is to remove as much of the tumor as possible. Experienced surgeons are often able to safely remove the entire tumor and completely cure the condition. 

First, it’s helpful to understand more about what a meningioma is and how it affects patients. A meningioma is a type of brain tumor that occurs in the meninges, which are the protective membranes surrounding the brain and spinal cord. Therefore, these tumors can either occur near the brain or near the spinal cord, spurring a range of symptoms including headaches, seizures, vision problems, weakness or numbness, memory problems, and speech difficulties. 

These symptoms arise when the tumor grows large enough that it causes pressure inside your head or presses on particular nerves. The severity of these symptoms is often what leads doctors to recommend surgery.

Surgery usually involves a craniotomy, which means opening up the skull. (The surgeon will close the skull after the procedure, and in many cases the incision is not even visible afterward.) The complexity of the procedure depends on the location of the meningioma: tumors that are close to the skull are simpler to remove, but tumors that are deeper in the brain, located at the skull base or that are growing around a blood vessel may require more sophisticated maneuvers for removal.

Preparation for a craniotomy may include stopping any blood thinning medications prior to surgery. You will also be instructed about any medications that your doctor does want you to take prior to the surgery. Almost all craniotomies occur under general anesthesia so that you won’t feel any pain during the procedure. 

A version of the procedure that does not require a craniotomy is one where the surgeon accesses the tumor with an endoscope that travels up through the nose.

Radiation therapy for meningiomas

In some cases, your doctor may recommend radiation therapy, or the use of high-energy beams to shrink the tumor. Radiation therapy is particularly helpful when the tumor is in a difficult-to-reach area or if other health factors prevent the patient from being a good candidate for surgery.  

Sometimes, your doctor may recommend radiation therapy after a surgical procedure, to destroy any remaining meningioma cells that still remain. There are several types of radiation therapy that may be relevant for meningioma treatment:

  • Stereotactic radiosurgery (SRS) sends several targeted beans towards a precise point, and usually takes place over a few hours in an outpatient setting.
  • Fractionated stereotactic radiotherapy (SRT) takes place over a longer period of time, sending small “fractions” of radiation for more sensitive areas or when the tumor is too large to be treated in one day.
  • Intensity-modulated radiation therapy (IMRT) is often deployed in complex situations where the meningioma shape demands a more tailored approach. IMRT gives your physician the ability to send multiple beams of different strengths to the area.
  • Proton beam radiation is an alternative to X-Ray radiation, and offers more precise targeting at the tumor. This option is newer in the medical field and may cause fewer side effects.

Other treatment options for meningiomas

It’s also possible that your doctor will simply advise observation for your meningioma. This is often the case for a patient with a small, asymptomatic incidentally discovered meningioma. There is a wide spectrum of symptoms for these types of tumors, and if you are not experiencing significant swelling or other adverse effects, it may make sense to hold off and observe the growth of the tumor before taking more targeted action. 

Your doctor will be able to recommend a regular cadence for imaging and observation. In conjunction with examinations, MRI tests over time can show the tumor’s progress and give your physician the information they need to assess your status.

Every meningioma is a little different, depending on its size, location, and growth rate. When it comes to treatment, it’s not only the characteristics of the tumor, but also the characteristics of the patient overall, that determines the best path forward.

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