What is Meningioma?

Meningioma is a tumor that develops from the meninges, the protective layers of tissue covering the brain and spinal cord. Many meningiomas are slow-growing and benign, but some can grow, press on nearby brain structures, involve the skull base, affect cranial nerves, or recur after treatment.

Meningiomas are commonly classified by CNS WHO grade. Grade 1 meningiomas are the most common and are usually lower-grade tumors. Grade 2 atypical meningiomas have a higher chance of recurrence. Grade 3 anaplastic meningiomas are malignant and more aggressive. The tumor’s grade, location, size, growth pattern, symptoms, and relationship to nearby brain structures all help guide treatment planning.

De Novo Brain & Spine evaluates adult patients with suspected or confirmed meningioma to help determine the appropriate next step. Evaluation may include neurological examination, brain MRI, CT imaging, review of prior scans, observation with repeat imaging, surgical consultation, pathology review, radiation oncology coordination, or additional specialty care when needed.

Common Signs and Symptoms

Meningioma symptoms depend on the tumor’s size, location, growth rate, and pressure on nearby brain, skull base, cranial nerve, or spinal structures. Some meningiomas are found incidentally on imaging and may not cause symptoms.

Common signs and symptoms may include:

• Persistent or worsening headaches
• New-onset seizures
• Weakness, numbness, or tingling in the face, arm, or leg
• Vision changes, including blurred vision, double vision, or loss of part of the visual field
• Hearing changes or ringing in the ears
• Loss of smell, depending on tumor location
• Balance problems, dizziness, or trouble walking
• Trouble speaking, understanding speech, or finding words
• Memory problems, confusion, or difficulty concentrating
• Personality changes, mood changes, or behavior changes
• Facial numbness, facial pain, or cranial nerve symptoms in some skull base tumors

Seek emergency medical care or call 911 for a first-time seizure, sudden weakness, sudden speech difficulty, sudden vision loss, severe confusion, loss of consciousness, or a rapidly worsening headache with vomiting or neurological changes.

What Causes This Condition

Most meningiomas develop without a clearly known cause. A diagnosis of meningioma does not usually mean that the patient did something to cause the tumor.

Possible risk factors may include:

• Prior therapeutic radiation exposure to the head or brain
• Neurofibromatosis type 2, also called NF2, a rare inherited condition associated with certain nervous system tumors
• Increasing age
• Biological and hormonal factors, although the relationship between hormones and meningioma growth is complex and not the same as a direct cause

Doctors may also review tumor-specific features to guide treatment planning. These may include CNS WHO grade, tumor location, brain invasion, extent of resection, recurrence history, and selected molecular findings when appropriate.

These details help classify the meningioma and estimate clinical behavior, but they are not lifestyle causes.

How It Is Diagnosed

Meningioma cannot be diagnosed by symptoms alone. Diagnosis usually requires medical history, neurological examination, and imaging. Tissue testing may be needed when surgery or biopsy is performed.

Common diagnostic steps may include:

• Medical history and neurological examination to evaluate strength, sensation, reflexes, vision, hearing, speech, balance, coordination, memory, and cognitive function
• MRI of the brain with and without contrast, often the main imaging study used to evaluate a suspected meningioma
• CT scan of the head, which may help evaluate calcification, bone involvement, or urgent symptoms
• Review of prior imaging to determine whether the tumor is stable, growing, or changing over time
• MR angiography, CT angiography, or catheter angiography in selected cases when blood vessel involvement needs clarification
• Visual field testing or ophthalmologic examination when the tumor is near the optic nerves, optic chiasm, orbit, or skull base
• Surgical planning imaging when removal of the tumor is being considered
• Neuropathology review when tissue is obtained to determine tumor type and CNS WHO grade
• Molecular testing in selected cases when it may help clarify tumor behavior, recurrence risk, or treatment planning

The goal of diagnosis is to understand the tumor’s location, size, grade when known, relationship to nearby brain structures, and whether it is causing symptoms or growth over time.

Treatment Options

Meningioma treatment depends on the tumor’s size, location, grade, growth pattern, symptoms, imaging findings, neurological examination, surgical risk, and the patient’s overall health. Not every meningioma requires immediate surgery.

Treatment options may include:

• Observation with repeat MRI scans for selected small, stable, or asymptomatic meningiomas
• Medication for symptom control, such as anti-seizure medication when seizures occur or corticosteroids in selected situations involving swelling
• Image-guided craniotomy for meningioma resection when surgery is appropriate to remove tumor, relieve pressure, confirm diagnosis, or protect neurological function
• Maximal safe resection, which means removing as much tumor as safely possible while protecting nearby brain, blood vessels, cranial nerves, and skull base structures
• Skull base surgical approaches for selected meningiomas near the optic nerves, cavernous sinus, sphenoid wing, clivus, posterior fossa, or other skull base regions
• Radiation therapy or stereotactic radiosurgery when recommended for selected tumors, residual tumor, recurrent meningioma, higher-grade meningioma, or tumors that are not ideal surgical candidates
• Treatment for recurrent meningioma, which may include repeat surgery, radiation therapy, radiosurgery, clinical trial discussion, or continued monitoring depending on the case
• Rehabilitation and supportive care to help with strength, balance, vision, speech, cognition, or daily function when symptoms are present

Surgery may be considered when a meningioma is growing, causing symptoms, pressing on important brain or nerve structures, causing seizures, affecting vision or hearing, or when tissue diagnosis is needed. The safest plan depends on the tumor’s anatomy and the patient’s individual condition.