Meningiomas are tumors of the meninges that can compress adjacent brain tissue. Symptoms depend on the tumor’s location. Diagnosis is by MRI with contrast agent. Treatment may include excision, stereotactic radiosurgery, and sometimes radiation therapy.
Meningiomas, particularly those < 2 cm in diameter, are among the most common intracranial tumors. Meningiomas are the only brain tumor more common among women (1). These tumors tend to occur in middle-aged and older adults, with a median age of 67 (2) but can occur during childhood.
Meningiomas, which are usually benign, can develop wherever there is dura, most commonly over the convexities near the venous sinuses, along the base of the skull, and in the posterior fossa and rarely within ventricles. Multiple meningiomas may develop. Meningiomas compress but do not invade brain parenchyma. They can invade and distort adjacent bone.
There are many histologic types; all follow a similar clinical course, and some become malignant.
(See also Overview of Intracranial Tumors.)
References
1. Cao J, Yan W, Li G, et al: Incidence and survival of benign, borderline, and malignant meningioma patients in the United States from 2004 to 2018. Int J Cancer 151(11):1874-1888, 2022. doi: 10.1002/ijc.34198
2. Ostrom QT, Price M, Neff C, et al: CBTRUS statistical report: Primary brain and other central nervous system tumors diagnosed in the United States in 2016–2020. Neuro-Oncology 25(Suppl 4):iv1-iv99, 2023. https://doi.org/10.1093/neuonc/noad149
Symptoms and Signs of Meningiomas
Symptoms of meningiomas depend on which part of the brain is compressed and thus on the tumor’s location (see table Symptoms of Meningiomas by Site). Midline tumors in older adults can cause dementia with few other focal neurologic findings.
Symptoms of Meningiomas by Site
Site | Findings |
|---|---|
Base of skull | Visual loss Oculomotor palsies Exophthalmos |
Cerebral convexities | Focal seizures Cognitive deficits Ultimately, signs of increased intracranial pressure |
Clivus and apical petrous bone | Gait disturbance Limb ataxia Deficits referable to the 5th, 7th, and 8th cranial nerves |
Foramen magnum | Ipsilateral suboccipital pain Paresis that begins in the ipsilateral arm and progresses to the ipsilateral leg, then to the contralateral leg and arm Sometimes Lhermitte sign Cranial nerve deficits (eg, dysphagia, dysarthria, nystagmus, diplopia, facial hypoesthesia) |
Olfactory groove | Anosmia Sometimes papilledema and visual loss |
Parasagittal or falx | Spastic paresis or sensory loss, usually beginning in the contralateral leg, but occasionally bilateral Cognitive deficits |
Posterior fossa tentorial tumors that extend superiorly or inferiorly | Hydrocephalus |
Sphenoid wing: | |
| Oculomotor palsies Facial numbness |
| Visual loss Exophthalmos |
| Seizures Headaches |
Tuberculum sellae | Visual loss Bone changes sometimes visible with imaging |
* Meningioma en plaque involves spread into the dura, with dural thickening and invasion of adjacent bone; the tumor sometimes grows into the temporal bone. | |
Diagnosis of Meningiomas
MRI
Image courtesy of William R. Shapiro, MD.
Diagnosis of meningiomas is similar to that of other brain tumors, usually by MRI with a paramagnetic contrast agent. Bone abnormalities (eg, brain atrophy, hyperostosis around the cerebral convexities, changes in the tuberculum sellae) may be seen incidentally on CT or plain x-rays.
Treatment of Meningiomas
For symptomatic or enlarging meningiomas, surgical excision or radiation therapy
For asymptomatic small meningiomas, particularly in older adults, monitoring with serial neuroimaging is sufficient.
Symptomatic or enlarging meningiomas should be excised if possible. In the following cases, surgery may cause more damage than the tumor and is thus deferred:
The meningiomas are large.
They encroach on blood vessels (usually surrounding veins).
They are close to critical brain areas (eg, brain stem).
Stereotactic radiosurgery is used for surgically inaccessible meningiomas and electively for other meningiomas. It is also used when tumor tissue remains after surgical excision or when patients are older.
If stereotactic radiosurgery is impossible or if a meningioma recurs, radiation therapy may be useful.
Key Points
Meningiomas are tumors of the meninges that are usually but not always benign.
They occur at a median age of 67 and are more common among women.
Symptoms vary greatly depending on the location of the tumor.
Excise symptomatic or enlarging tumors; use stereotactic radiosurgery if tumor remains after excision or cannot be excised completely.
