Information on Meningioma
Meningiomas are the most common benign tumors of the brain (95% of benign tumors). However they can also be malignant. They arise from the arachnoidal cap cells of the meninges and represent about 15% of all primary brain tumors. They are more common in females than in males (2:1) and have a peak incidence in the sixth and seventh decades. Most cases are sporadic while some are familial. There has been some evidence that persons who have undergone radiation to the scalp are more at risk for developing meningiomas. The most frequent genetic mutations involved in meningiomas are inactivation mutations in the neurofibromatosis 2 gene (merlin) on chromosome 22q.
Meningiomas are benign tumors, although there are rare malignant meningiomas. The majority of meningiomas are classified as meningotheliomatous or syncitial, fibrous, transitional, or angioblastic. The World Health Organization has developed a grading system, which scores architecture, cellularity, nuclear pleomorphism, mitotic figures, necrosis, and brain infiltration. Using the WHO scoring system, tumors are graded as grade I (benign), grade II (atypical), grade III (anaplastic) and grade IV (sarcomatous). Over 90 percent of tumors are classified as benign based on this system. The grading system has prognostic significance for behavior.
Meninges are the three layers of tissue that cover and protect the brain and spinal cord. From the outermost layer inward they are: the dura mater, arachnoid mater, and pia mater. A meningioma grows from the arachnoid gap cells that form the middle layer, the arachnoid mater, and are usually attached to the dura. Some meningiomas contain cysts or calcified mineral deposits, and others contain hundreds of tiny blood vessels. Because meningiomas tend to grow inward, they commonly cause pressure on the brain or spinal cord. Although less common, meningiomas can grow outward, causing the skull to thicken. Meningiomas grow very slowly, and it is oftentimes many years before they cause symptoms.
Meningiomas can invade the bone or muscle, but such invasion is not a sign of malignancy. Meningiomas can grow through the holes (foramina) at the base of the skull and grow outside the skull. As meningiomas grow, they compress the normal brain. Old hemorrhage may be present. En plaque meningiomas are flat and hard. They grow on the surface of the brain. Ventricular meningiomas grow in the lateral, 3rd or 4th ventricles, and may obstruct CSF (spinal fluid) flow. Meningoimas are rarely cystic (5% of cases).
Radiation therapy: If your meningioma can’t be completely removed, your doctor may recommend radiation therapy following surgery. The goal of radiation therapy is to destroy any remaining meningioma cells and reduce the chance that your meningioma may recur. During radiation therapy, your health care team positions you on a table. A large radiation machine moves around you aiming a high-powered energy beam at precise points on your body to target the meningioma cells and leave your healthy cells unharmed. You typically undergo radiation therapy daily for five or six weeks.