Meningiomas

"It is recommended that treatment decisions be made within multidisciplinary units, where each specialist can contribute their experience for the benefit of the patient".

DR. BARTOLOMÉ BEJARANO
SPECIALIST. BRAIN TUMOUR AREA

Meningioma is the most common benign cranial tumor. It comes from cells in the coverings of the brain.

The meningioma does not grow inside the brain but it compresses it, normally pushing the brain parenchyma. Depending on where it is born, it can be more or less difficult to treat.

They are somewhat more frequent in women than in men and their incidence increases throughout life.

In addition to the risks inherent to each tumor due to its size and location, meningiomas are characterized by a high risk of deep vein thrombosis and pulmonary thromboembolism.

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What are the symptoms of meningioma?

The symptoms depend on the site of origin and on the fact that they are slow-growing tumors, which is why they mainly give symptoms of slow compression of the brain tissue.

They are tumors that grow over many years, so the symptoms can appear very slowly, although this is not always the case.

They can produce progressive headaches, or almost any type of neurological disorders or epileptic seizures.

The most common symptoms are:

  • Progressive headaches.
  • Epileptic seizures.

Do you have any of these symptoms?

You may have a meningioma

What are the causes of meningioma?

Genetic abnormalities have been described as the cause, although most appear in patients with no family history. The presence of multiple meningiomas is frequent in patients with neurofibromatosis type 2.

Approximately two thirds of meningiomas express progesterone receptors, rarely estrogen receptors. The acceleration of their growth during pregnancy and an increased incidence in women who have received hormone substitutes after menopause have been described.

What is the prognosis of meningioma?

After complete removals, most tumors do not grow back. If there is any residual tumor left, the chances of it growing back and causing problems again increase over the years.

It is difficult to predict the evolution of a specific case, since there is a very large variability in the behavior of tumors that appear the same when analyzed.

How is meningioma diagnosed?

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After clinical suspicion of meningioma, imaging tests such as MRI easily locate the lesion and often allow suspicion of the correct diagnosis.

The definitive diagnosis is that of the biopsy of the tumor; most meningiomas are benign, grade I, although there may be grade 2 or 3 variants that are of worse prognosis.

Atypical meningioma (grade II)
Atypical meningioma represents a variant of meningioma in which histological characteristics of certain histological aggressiveness are associated with a higher clinical tendency to recurrence.

Diagnosis can be difficult since criteria vary slightly from one classification to another.

Both atypical and anaplastic meningioma can present with this aspect from the beginning or in the recurrence of an initially typical meningioma.

The management of atypical meningiomas is initially similar to the typical ones, being surgery the fundamental element of treatment, despite their atypical character they may not recur after a complete removal including the implantation basis. However, many authors recommend post-surgical radiotherapy, without clear evidence for or against it. Recently, a retrospective study of 108 atypical meningiomas found that they recur less if postoperative radiation therapy is administered.

Anaplastic meningioma (grade III)
They are even less frequent than the atypical ones. Histologically, they present characteristics of frank malignancy.

The prognosis is clearly worse than in the atypical. In anaplastic meningioma, very rapid recurrences and distant metastases are possible. In this type of tumor, chemotherapy is usually used, the most commonly used schemes being cyclophosphamide, adriamycin and vincristine.

How do we treat it?

The initial treatment of meningiomas is surgical removal. Recurrences are possible despite removal, but are very rare when the entire tumor and its base have been removed, and more frequent if some area cannot be removed.

As an alternative to surgery, ionizing radiation can be considered, either as a single dose (radiosurgery), as conventional fractionated radiotherapy, or as stereotactic fractionated radiotherapy. In general, the radiation treatment option has a lower immediate risk than surgery, and it is a good option for stopping tumor growth. The problem is that not all tumors are stopped and as the years go by, they may start growing again.

Apart from the indication of radiosurgery as an alternative to surgery, there is the option of using it as a combined treatment. In cases of large tumors with areas whose removal poses an added risk of morbidity, such as areas of skull-based implantation, or cavernous sinus invasions.

Where do we treat it?

IN NAVARRA AND MADRID

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In the Brain Tumor Area we offer maximum safety and efficiency in brain tumor surgery, being the first hospital with a high field magnetic resonance within the operating room.

We have a highly specialized team in the surgery of brain tumors, with more than 15 years of experience.

The individualized treatment of each case by an interdisciplinary team allows us to offer the best alternative to each patient.

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