Meningioma (mostly benign brain tumour)

Definition:
A meningioma is a tumor that arises from the meninges — the membranes that surround your brain and spinal cord. Most meningiomas are noncancerous (benign), though, rarely, a meningioma may be cancerous (malignant). Some meningiomas are classified as atypical, meaning they’re neither benign nor malignant, but rather something in between.

Symptoms typically appear gradually and vary depending on the location and brain area affected. Because these are slow growing tumors, not all meningiomas need to be treated immediately.A meningioma that causes no significant signs and symptoms may be monitored over time. Treatment options focus on removing the tumor and relieving the compression on the brain

Three layers of membranes, called meninges, lying just under the skull, 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 cells that form the middle layer, and are firmly 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. They can also grow outward causing the skull to thicken (hyperostosis).

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Pic-1.Meningiomas grow from the dura covering of the brain. As the tumor grows, it compresses and displaces normal brain tissue. Increasing size, pressure and swelling cause neurologic symptoms.

The World Health Organization (WHO) developed a classification system for all known tumor types, including meningiomas. Tumors are classified by their cell type and grade by viewing the cells taken during a biopsy under a microscope. Treatment varies depending on the grade of your meningioma.

•WHO, Grade I meningiomas are the slowest growing. If the tumor is not causing symptoms, it may be best to observe its growth over time with periodic MRI scans. If there is a chance the tumor will grow enough in your lifetime to cause symptoms, then surgical removal may be recommended. Most Grade I meningiomas are treated with surgery and continued observation.

•WHO, Grade II meningiomas are called atypical. They are slightly more aggressive in growth than Grade I and have a slightly higher risk of recurrence. Surgery is the first line treatment for these types of meningiomas. Some Grade II meningiomas require radiation after surgery.

•WHO, Grade III meningiomas are the most aggressive and are called malignant or anaplastic. Malignant meningiomas account for less than 1% of all meningiomas. Surgery is the first line treatment for Grade III meningiomas followed by radiation. If the tumor recurs, chemotherapy is used.

Meningiomas represent about 20% of all primary brain tumors and 12% of all spinal cord tumors. They can occur in children, but most often occur in adults between the ages of 40 and 60 years. Most meningiomas are benign (not cancerous), as less than 10% of meningiomas are malignant. While malignant meningiomas occur in both women and men, benign meningiomas occur most often in women.

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Symptoms:
mall tumors (e.g., < 2.0 cm) are usually incidental findings at autopsy without having caused symptoms. Larger tumors can cause symptoms depending on the size and location.

*Focal seizures may be caused by meningiomas that overlie the cerebrum.

*Progressive spastic weakness in legs and incontinence may be caused by tumors that overlie the parasagittal frontoparietal region.

*Sylvian tumors may cause myriad motor, sensory, aphasic, and seizure symptoms, depending on the location.

*Increased intracranial pressure eventually occurs, but is less frequent than in gliomas.

Meningiomas grow slowly; it may take years before they cause symptoms. Some people with meningiomas have no symptoms. The tumor may be found incidentally on a diagnostic scan performed for another reason such as a trauma.  Larger tumors can cause symptoms depending on the size and location. They often first appear as headaches and seizures, primarily due to increased pressure of the growing tumor. Weakness in the arms or legs, or loss of sensation, may occur with spinal cord meningiomas.

Meningiomas are often named according to their location and symptoms:
•Convexity meningiomas: grow on the surface of the brain. They may not produce symptoms until they reach a large size. Symptoms include seizures, neurological deficits, or headaches.

•Falx and parasagittal meningiomas: grow from the dural fold, called the falx, which runs between the left and right sides of the brain. The falx contains two large blood vessels (superior and inferior sagittal sinuses). Because of the danger of injuring the sinuses, removing a tumor in the falx or parasagittal region can be difficult. Symptoms may include personality changes, headache, vision problems, and arm or leg weakness.

•Olfactory groove meningiomas: grow along the olfactory nerves that run between the brain and the nose. These tumors often cause a loss of smell. They can compress the frontal lobes causing personality changes that may be mistaken for depression. They can also compress the optic nerves to the eyes, causing visual problems such as loss of specific areas within your field of vision, or even blindness.

•Sphenoid meningiomas: grow along the sphenoid ridge, which lies behind the eyes. These tumors can cause visual problems, loss of sensation in the face, or facial numbness. Tumors in this location can sometimes encase the major blood vessels of the brain (e.g. cavernous sinus, or carotid arteries) as well as the cranial nerves in the area making them difficult to completely remove.

•Posterior fossa meningiomas: grow along the underside of the brain near the brainstem and cerebellum. These tumors can compress the cranial nerves causing facial symptoms or loss of hearing. Petroclival tumors can compress the trigeminal nerve, resulting in facial pain (trigeminal neuralgia) or spasms of the facial muscles. Foramen magnum meningiomas grow near the area where the spinal cord connects to the brain and can cause headaches, or other signs of brainstem compression such as difficulty walking.

•Intraventricular meningiomas: grow inside the fluid-filled ventricles deep inside the brain. They can block the flow of cerebrospinal fluid (CSF) causing hydrocephalus, which can produce headaches and dizziness.

•Intraorbital meningiomas: grow around the eye sockets of the skull and can cause pressure in the eyes to build up, giving a bulging appearance. They can also cause loss of vision.

•Spinal meningiomas: grow predominantly in the thoracic spine. They can cause back pain (typically at night) or loss of sensation and paralysis of the legs from compression of the spinal nerves.

Causes:
Scientists are not certain what causes meningioma tumors, although several theories are being investigated. Most agree that a malformed chromosome is the most common abnormality in meningiomas, but the cause of this abnormality is unknown.Most cases are sporadic while some are familial. Persons who have undergone radiation to the scalp are more at risk for developing meningiomas. People with a genetic disorder known as neurofibromatosis type 2 (NF2) are more likely to develop meningiomas. Of people with malignant meningiomas, a higher percent have mutations in NF2. Studies have also found that patients who received radiation treatment to the head for medulloblastomas, ependymomas, or other tumors are at higher risk for developing meningiomas later in life secondary to the radiation.

 

Diagnosis:
First, the doctor will ask about your personal and family medical history and perform a complete physical examination. In addition to checking your general health, the doctor performs a neurological exam. This includes checks for mental status and memory, cranial nerve function (sight, hearing, smell, tongue and facial movement), muscle strength, coordination, reflexes, and response to pain. If a problem is found, the doctor may order diagnostic imaging tests such as computerized tomography (CT) or magnetic resonance imaging (MRI) scans to help determine the size, location, and type of tumor, if one exists . Skull x-rays may be obtained if the tumor is believed to involve the bone. For spinal cord tumors, a myelogram may be done, and in some cases, angiograms, or x-rays of the blood vessels, are necessary. The diagnosis can be confirmed by a biopsy.

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Risk Factors:
*Radiation treatment. Radiation therapy that involves radiation to the head may increase the risk of a meningioma.

*Female hormones. Meningiomas are more common in women, leading doctors to believe that female hormones may play a role.

*An inherited nervous system disorder. The rare disorder neurofibromatosis type 2 increases the risk of meningioma and other brain tumors.
Treatment:
The treatment you receive for a meningioma depends on many factors, including the size of your meningioma, where it’s situated and how aggressive it’s believed to be. Your doctor will also take into consideration your overall health and your goals for treatment.

Wait-and-see approach
Immediate treatment isn’t necessary for everyone with a meningioma. A small, slow-growing meningioma that isn’t causing signs or symptoms may not require treatment.

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If the plan is not to undergo treatment for your meningioma, you’ll likely have brain scans periodically to evaluate your meningioma and look for signs that it’s growing. Your doctor creates a personalized follow-up schedule for you. For instance, you might undergo brain scans every few months at first and then have scans done annually. If your doctor determines your meningioma is growing and needs to be treated, you have several treatment options.

Surgery
If your meningioma causes signs and symptoms or shows signs that it’s growing, your doctor may recommend surgery. Surgeons work to remove the meningioma completely. But because a meningioma may occur near many delicate structures in the brain or spinal cord, it isn’t always possible to remove the entire tumor. In those cases, surgeons remove as much of the meningioma as possible.

The type of treatment, if any, you need after surgery depends on several factors.

*If no visible tumor remains, then no further treatment may be necessary. However, you will have periodic follow-up scans.

*If the tumor is benign and only a small piece remained, then your doctor may recommend periodic follow-up scans only. In some cases, small, leftover tumors may be treated with a form of radiation treatment called stereotactic radiosurgery.

*If the tumor is atypical or malignant, you’ll likely need radiation.

Surgery may pose risks including infection and bleeding. The specific risks of your surgery will depend on where your meningioma is located. For instance, surgery to remove a meningioma that occurs around the optic nerve can lead to vision loss. Ask your surgeon about the specific risks of your surgery…..click & see

A craniotomy is cut in the skull to expose the tumor. After the tumor is removed, brain tissue can re-expand in the cavity……..click & see

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. Radiation therapy uses a large machine to aim high-powered energy beams at the tumor cells.

Advances in radiation therapy increase the dose of radiation to the meningioma while reducing radiation to healthy tissue. These include fractionated stereotactic radiotherapy (SRT) and intensity-modulated radiotherapy (IMRT).

Radiosurgery
Radiosurgery is a type of radiation treatment that aims several beams of powerful radiation at a precise point. Contrary to its name, radiosurgery doesn’t involve scalpels or incisions. Radiosurgery typically is done in an outpatient setting in a few hours. Radiosurgery may be an option for people with meningiomas that can’t be removed with conventional surgery or for meningiomas that recur despite treatment.

Fractionated radiation
For tumors too large for radiosurgery or those in an area that can’t tolerate the high intensity of radiosurgery — such as near the optic nerve — a possible option is fractionated radiation. This involves delivering the radiation in small fractions over time. For example, this approach might require one treatment a day for 30 days.

Drugs
For people with meningiomas that recur or don’t respond to surgery and radiation, doctors are trying different system treatments. Unfortunately, most chemotherapy has not proved valuable, but some drugs, such as hydroxyurea (Droxia, Hydrea), are sometimes used. Other drugs are being tested as well, such as those that inhibit the formation of blood vessels (angiogenesis inhibitors). Much more study is needed.

Complications:
A meningioma and its treatment, typically surgery and radiation therapy, can cause long-term complications, including:

*Difficulty concentrating

*Memory loss

*Personality changes

*Seizures

Your doctor can treat some complications and refer you to specialists to help you cope with other complications.

Alternative Medications:
Alternative medicine treatments can’t treat meningiomas, but some may help provide relief from treatment side effects or help you cope with the stress of having a meningioma.

Alternative medicine therapies that may be helpful include:

*Acupuncture

*Hypnosis

*Massage

*Meditation

*Music therapy

*Relaxation exercises

Discuss options with your doctor.

Coping and support
Being diagnosed with a meningioma can be overwhelming. As you come to terms with your diagnosis, your life can be turned upside down with visits to doctors and surgeons as you prepare for your treatment. To help you cope, try to:

*Learn everything you can about meningiomas. Ask your health care team where you can get more information about meningioma and your treatment options. Visit your local library and ask a librarian to help you track down reliable resources for more information, including online sources. Write down your questions so that you’ll remember to ask them at your next appointment with your doctor. The more you know about your condition, the better prepared you’ll be to make decisions about your treatment.

*Build a support network. Having friends and family supporting you can be valuable. You may find it helps to have someone to talk to about your emotions. Other people who may provide support include social workers and psychologists — ask your doctor for a referral if you feel that you need someone else to talk to. Talk with your pastor, rabbi or other spiritual leader. Other people with meningiomas can offer a unique perspective, so consider joining a support group – whether it’s in your community or online. Ask your health care team about brain tumor or meningioma support groups in your area, or contact the American Brain Tumor Association.

*Take care of yourself. Try to stay healthy during your treatment for a meningioma by taking care of yourself. Eat a diet rich in fruits and vegetables, and get moderate exercise daily if your doctor allows it. Get enough sleep so that you wake feeling rested. Reduce stress in your life by focusing on what’s important to you. These measures won’t cure your meningioma, but they may help you feel better as you recover from surgery or help you to cope during radiation therapy.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.mayfieldclinic.com/PE-MENI.htm
http://en.wikipedia.org/wiki/Meningioma
http://www.mayoclinic.com/health/meningioma/DS00901
http://www.bbc.co.uk/health/physical_health/conditions/braintumourbenign.shtml

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