What is a Meningioma?
Meningiomas are the most common type of primary brain tumour. They develop from the meninges, the thin layers of cells that form the protective lining around the brain and spinal cord. This lining not only supports and protects the central nervous system, but also plays a role in regulating immune cells within these tissues.
Most meningiomas grow slowly and are classified as WHO grade 1 tumours, with many patients experiencing excellent long-term outcomes. A smaller proportion are classified as WHO grade 2 (atypical) or WHO grade 3 (anaplastic or malignant), which tend to grow more aggressively and are more likely to recur after treatment.
Because meningiomas arise from the tissue surrounding the brain rather than the brain itself, many are considered benign tumours rather than brain cancers. . However, they can still cause serious health problems if they grow large, compress important brain structures, or behave more aggressively.
Meningiomas that invade nearby brain tissue or surrounding structures are more likely to recur and may require more intensive treatment and long-term monitoring.
Types of Meningioma
The World Health Organization (WHO) classifies meningiomas into three grades based on their microscopic appearance, growth characteristics, and other features associated with tumour behaviour. Tumours with more rapidly dividing cells tend to behave more aggressively, have a higher risk of coming back, and are associated with a poorer overall prognosis. This grading also helps doctors decide on the most appropriate treatment approach.
Grade I meningioma is the most common form, accounting for over 80% of cases. It includes several cell types such as meningothelial, fibrous, and transitional meningiomas. These tumours usually grow slowly and are associated with a lower risk of recurrence than higher-grade meningiomas. .
Grade II meningioma includes atypical, clear cell, and chordoid subtypes. These tumours contain more actively dividing cells than Grade I tumours and tend to grow faster. They also have a higher chance of recurring after treatment. Grade II meningiomas make up less than 20% of cases.
Grade III meningioma is the most aggressive form. These tumours show a high rate of cell division and often behave aggressively, with a substantial risk of recurrence and poorer long-term outcomes. Grade III meningiomas are rare, accounting for fewer than 5% of cases.
Meningioma Symptoms
Meningioma is usually a slow-growing tumour, and symptoms may not appear until it has grown significantly. In some cases, people may have no symptoms for a long period of time. Early symptoms are often non-specific, but as the tumour grows, symptoms usually develop according to the location of the tumour and the structures it affects. The exact symptoms vary mainly according to the tumour’s location, size, growth rate, and the amount of swelling it causes in surrounding tissues.
Common symptoms include:
- Headaches, often caused by swelling or increased pressure inside the skull
- Cranial nerve problems, which may affect facial movement, sensation, or eye function
- Difficulties with speech and language
- Motor and sensory changes, such as weakness, numbness, or coordination problems
- Cognitive changes, including problems with memory, attention and decision-making
- Seizures
- Vision changes, such as blurred or double vision
- Mood or personality changes
How Is Meningioma Diagnosed?
Meningioma diagnosis usually begins with imaging tests such as computed tomography (CT) and magnetic resonance imaging (MRI). MRI is generally preferred because it provides more detailed images of the brain and tumour. However, CT scans may be used when MRI is not suitable, and can also help identify calcification or changes to the surrounding bone.
Doctors often use a contrast dye during MRI to make the tumour more visible and easier to identify. MRI findings may provide clues about whether a meningioma is likely to behave more aggressively, although tumour grade can only be confirmed by examining tumour tissue under the microscope.
In some cases, doctors may also request a positron emission tomography (PET) scan. This is possible because meningioma cells often express a protein called somatostatin receptor 2 (SSTR2). PET imaging can help distinguish meningioma tissue from surrounding structures and may improve tumour delineation (the process of defining the precise boundaries of a tumour). This information can be especially useful when planning surgery or radiotherapy.
A definitive diagnosis is usually made by examining tumour tissue obtained during surgery or, less commonly, through a biopsy. This allows pathologists to determine the tumour grade and subtype.
Living With Meningioma
Living with meningioma often means managing not only symptoms caused by the tumour, but also side effects that continue after treatment has finished. These effects can range from fatigue to neurological changes and may affect daily activities and quality of life.
Some patients experience difficulties with sleep, as well as challenges in physical, social, and emotional functioning. Memory and attention can also be affected, making everyday tasks more difficult.
Fatigue is one of the most common long-term effects of both the tumour and its treatment. However, regular physical activity, rehabilitation and supportive behavioural strategies during treatment may help reduce fatigue .
Even after successful treatment, many patients require ongoing MRI scans to monitor for tumour recurrence or growth. The frequency of follow-up imaging depends on the tumour grade, treatment received, and individual risk factors.
In addition, tailored neurocognitive and neuropsychiatric support, along with physical rehabilitation, can help patients manage these ongoing symptoms more effectively. This support can also ease the burden on caregivers, who often play an important role during recovery.
Meningioma Treatment and Management Options
Treatment for meningioma is personalised for each patient and may include observation or the “wait and see” approach, surgery, radiotherapy, and, in rare cases, systemic therapies. Some patients with very small or asymptomatic tumours may initially be monitored with regular MRI scans to track whether the tumour grows over time. In some cases, the tumour may remain stable and not require immediate treatment.
Surgery and Radiotherapy for Meningioma
If the tumour increases in size or causes symptoms, doctors may recommend surgery to remove as much of it as safely possible. Complete removal can lead to a good prognosis, but this depends on the tumour’s location, especially whether it involves important veins, nerves, or blood vessels in the brain, as well as the patient’s overall health. Neurosurgeons also monitor not only tumour removal but also functional outcomes after surgery, as preserving the quality of life is an important part of treatment.
Radiotherapy may be used when surgery is not possible or not appropriate. Techniques such as stereotactic or fractionated radiotherapy can also be used after partial tumour removal to reduce the risk of recurrence. For Grade II and III meningiomas, radiotherapy is often given after surgery as an adjuvant treatment to lower the chance of the tumour returning.
Targeted treatments and Clinical Trials for Meningioma
In cases where surgery and radiotherapy are no longer effective or are not suitable, doctors may consider enrolment in clinical trials investigating targeted therapies, immunotherapies, or other systemic treatments.
However, these approaches are still under investigation and have not yet become standard treatments for most meningiomas.
The risk of recurrence varies significantly according to tumour grade, extent of surgical removal, and tumour location. Higher-grade meningiomas are generally more likely to recur and often require closer long-term monitoring.
Many meningiomas are slow-growing, but that doesn’t mean their impact is small. Changes in cognition, personality, or physical function can develop gradually, often placing increasing responsibility on carers over time.
For families, the uncertainty of “watch and wait” or the possibility of recurrence can also take a toll.
Support is available to help you navigate these challenges — from managing day-to-day care to accessing services and financial assistance. The National Advocacy Service can help you understand your rights and access the support you’re entitled to. You can also visit our Support Hub for practical information and resources to help you following a diagnosis.
References
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- Goldbrunner, R, Stavrinou, P, Jenkinson, MD, Sahm, F, Mawrin, C, Weber, DC, Preusser, M & Minniti, G 2021, ‘EANO guideline on the diagnosis and management of meningiomas’, Neuro-Oncology, vol. 23, no. 11, pp. 1821-1834.
- Huang, Y. H., Hong, C. Z., Wu, W. T., Li, K. T., & Chou, L. W. (2014). Brain meningioma with initial manifestation similar to cervical radiculopathy: a case report. Neuropsychiatr Dis Treat, 10, 1175-1181. https://doi.org/10.2147/ndt.S64192
- Huntoon, K., Toland, A. M. S., & Dahiya, S. (2020, 2020-October-23). Meningioma: A Review of Clinicopathological and Molecular Aspects [Review]. Frontiers in Oncology, Volume 10 – 2020. https://doi.org/10.3389/fonc.2020.579599
- Nassiri, F., Suppiah, S., Wang, J. Z., Badhiwala, J. H., Juraschka, K., Meng, Y., Nejad, R., Au, K., Willmarth, N. E., Cusimano, M., & Zadeh, G. (2020, Jan-Dec). How to live with a meningioma: experiences, symptoms, and challenges reported by patients. Neurooncol Adv, 2(1), vdaa086. https://doi.org/10.1093/noajnl/vdaa086
- Ogasawara, C., Philbrick, B. D., & Adamson, D. C. (2021). Meningioma: A Review of Epidemiology, Pathology, Diagnosis, Treatment, and Future Directions. Biomedicines, 9(3), 319. https://www.mdpi.com/2227-9059/9/3/319
- Rogers, L, Barani, I, Chamberlain, M, Kaley, TJ, McDermott, M, Raizer, J, Schiff, D, Weber, DC & Wen, PY 2015, ‘Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review’, Journal of Neurosurgery, vol. 122, no. 1, pp. 4-23.