How a Meningioma Is Treated

The treatment of meningioma varies depending on the size and location of the tumor, the symptoms, and your overall health. The most common treatment options are surgery, radiation, watchful waiting, or a combination of these.

Most meningiomas are benign, or noncancerous, but in rare cases, they can be cancerous. Fortunately, most people with meningioma are able to live long, healthy lives after treatment. The 10-year survival rate after treatment for a benign tumor is 84%, and those with cancerous meningiomas have a 10-year survival rate of 62%.

This article will review the common treatment approaches for meningioma.

Watchful Waiting

If a meningioma isn't causing troublesome symptoms, your healthcare provider may recommend an approach known as watchful waiting or active surveillance.

This approach is most commonly used in patients with a growth smaller than 3 centimeters (cm), which is about the size of a grape, who have no symptoms. You can still be considered for a wait-and-see approach if you have symptoms but they do not severely impact your life.

With this treatment approach, you should expect to see your healthcare provider and have a magnetic resonance imaging (MRI) scan every six months to one year, if not more often.

During these follow-up appointments, your doctor will check for changes in the tumor. They will also ask if there have been any changes in your symptoms or any new symptoms. They may also do tests to check neurological function. You may also be asked to walk heel-to-toe or stand with your feet together and eyes closed to check your balance and coordination.

If everything is the same, you can continue with the watchful waiting plan. However, if there are changes, your doctor will likely start discussing other treatment options or increase the frequency of your appointments.

Surgery

Surgery is the next most common treatment option for meningioma. While surgery is the most invasive option and comes with risks, it’s also the best chance for removing the entire growth and reducing the opportunity for the tumor to return.

Most meningiomas are removed using a surgical method called a craniotomy. During a craniotomy, a neurosurgeon makes an incision into the scalp. They then remove a piece of the skull so they can see the brain, as well as the tumor. 

During the procedure, the surgeon will remove as much of the tumor as possible. The overall goal of surgery is to remove as much of the tumor as possible without damaging the brain. Most cases have one of two possible outcomes:

• Total resection: In the best situation, the doctor can remove the entire tumor, leaving nothing behind. If this happens, you will likely need no follow-up treatment. The only follow-up you will have is an MRI scan at least once a year, if not more often, to ensure the meningioma isn't growing back.
• Partial resection: In this case, a small portion of the tumor may be left behind to preserve brain tissue. In this outcome, you may need to follow up with radiation treatment to kill the remaining tumor cells, depending on your circumstance. 

You will also need radiation after surgery if the tumor is considered malignant, or cancerous. 

This is serious surgery. It typically takes around three to six hours. However, there is a possibility it can take longer depending on individual circumstances. It also requires a hospital stay of a few days and, in some cases, rehab or physical therapy as part of the recovery process.

Radiation

Radiation is most commonly used as a follow-up treatment to surgery. The goal of radiation is to destroy any remaining tumor cells and prevent the tumor from recurring.

While radiation is mainly done after surgery, radiation can also be the first and only treatment used for some. For those with very small tumors, radiation may be the only treatment needed. And in those with inoperable tumors, radiation may be used to slow the tumor growth.

Those with very large tumors may need to start with radiation to reduce the risk of brain damage before going into surgery.

There are two options for radiation in the treatment of meningioma:

Traditional Radiation

Traditional or fractionated radiation is the most commonly known form of radiation. During this form of treatment, high-energy rays are directed at the tumor area to kill off the tumor cells. You will receive small doses of radiation five days a week for about five to six weeks.

The downside to this type of radiation is the inability to get the radiation in a small place without damaging nearby tissue. This is why stereotactic radiosurgery comes into play with meningiomas.

Stereotactic Radiosurgery

Stereotactic radiosurgery is a treatment that allows your healthcare team to tell a specialized machine where the growth is and focus multiple tiny radiation beams directly to the tumor.

The ability for stereotactic radiosurgery to be programmed to a precise area means less damage to the brain tissue around the tumor. When it comes to the brain, less tissue damage means a better chance of getting through treatment without brain damage. 

Within the field of stereotactic radiosurgery, there are different machines and methods that may be used to treat meningiomas, such as the following:

• Proton beam therapy is the newest form of radiosurgery. It uses protons to kill tumor cells instead of X-rays. This form of treatment is found only at a handful of hospitals in the United States but continues to grow in popularity. 
• Gamma Knife radiosurgery is a type of radiosurgery that uses focused beams of gamma radiation. It has been shown to be effective on benign or malignant tumors up to 4 cm in size.
• Linear accelerator (LINAC) is another type of machine that creates high-energy radiation with electricity, which is then precisely targeted at the tumor with pinpoint accuracy. 
  

Summary

A meningioma is a slow-growing tumor that forms in the brain or spinal cord. Treatment options vary depending on the size and location of the tumor, your overall health, and the rate that the tumor is growing. The most common treatment approaches are watchful waiting, surgical removal, and radiation, or some combination of those options. Your healthcare team will work with you to develop a treatment plan for your situation.

A Word From Verywell

Being treated for a meningioma can be frightening. Before you begin treatment, make sure you understand the goal of each treatment, along with the possible side effects. Be sure to discuss your concerns with your healthcare team. They are there to answer your questions and point you toward the support and resources you need. It's also important to have friends and loved ones to lean on during this time, so reach out to your community and let them know what you're going through.

Recovering from treatment for meningioma can also be a process. Some people will struggle with muscle weakness, coordination, or speech problems after brain surgery, so you may need physical or occupational therapy or a speech therapist to help you get back to a healthy, active life. Many people are able to live long, fulfilling lives after meningioma treatment.