Meningioma

What Causes Meningioma?

The root cause of a brain tumor is a mutation or damage in the genes that control the growth of affected cells. In a healthy cell, these genes prevent the cell from growing or reproducing too rapidly, and the genes can also determine the cell’s expected lifespan. In a tumor’s cells, the damage to the genes causes the cells to grow and reproduce rapidly, and the cells may live longer than usual. As this rapid growth and reproduction continue, the cells grow into an abnormal mass.

The specific cause of the gene damage that triggers a tumor’s formation is usually not identifiable. However, some risk factors that may play a role include:

• Age. Meningiomas are most common in people older than 65.
• Sex. Women are more likely to develop some types of meningioma, leading scientists to suspect a connection between the tumors and hormones.
• Obesity. Some studies have found an association between meningiomas and weight.
• Exposure to ionizing radiation such as X-rays

Is Meningioma Hereditary?

Most meningiomas do not appear to be linked to inherited traits. Instead, researchers believe most gene changes that cause tumors come from external environmental factors or changes within cells that occur randomly and with no external trigger. However, some types of meningiomas have been associated with the inherited disorder neurofibromatosis type 2.

How Is Meningioma Detected?

Meningiomas can be challenging to detect early because their symptoms may be too subtle to notice in the early stages of their growth. Slow-growing meningiomas may develop for years without producing symptoms, and some tumors never cause noticeable symptoms. Because their presence is subtle, meningiomas are often discovered by chance when a patient undergoes an imaging scan for some other reason.

Some warning signs of meningiomas include:

• Headaches
• Seizures
• Problems concentrating
• Problems with memory
• Problems with balance or coordination
• Weakness or numbness

How Is Meningioma Diagnosed?

Doctors may take several different diagnostic steps when they suspect that a patient may have a meningioma.

• Neurological exam. A basic neurological exam will test a patient’s reflexes, balance, coordination, strength, vision, and hearing. The results of this exam may prompt a doctor to look further for a tumor’s presence, and it may give a clue to the affected part of the brain, if any.
• Imaging. Imaging technologies are non-invasive ways to look at brain tissue and possibly detect a tumor’s presence. They may also be used to judge the tumor’s size, location, and growth. Magnetic resonance imaging (MRI) uses a strong magnetic field to produce images of the brain and central nervous system. Computerized tomography (CT) scan may also be used to look for tumors.
• Biopsy. Doctors may require a biopsy, in which a sample of the tumor is removed and analyzed by a pathologist. The biopsy might be conducted with surgery or, if the tumor is in a particularly hard-to-reach area, using a needle guided by imaging technology. A pathologist’s examination of the tissue sample can help suggest the best treatment course.

How Is Meningioma Treated?

Treatment of a meningioma can vary depending on the tumor’s growth rate, location, and size. In some cases, no treatment is necessary, and a doctor will recommend only monitoring the tumor.

Surgery

The most direct way to treat a brain tumor is to remove as much of it as possible with surgical intervention. Typically, the surgery involves opening the skull and removing the tumor while not damaging the surrounding healthy tissue. In many cases, the borders of a meningioma are well-defined, and the surgeon can remove all of the abnormal cells.

However, when a tumor is located in an especially sensitive area or has infiltrated surrounding brain tissue, the surgeon may not be able to remove all of the tumor, and other subsequent treatment options may be necessary.

Radiation Therapy

Radiation therapies involve using high-energy x-rays to target and kill tumor cells directly. The radiation is typically focused on the tumor to prevent damaging healthy cells. Radiation therapy is often used when the tumor can’t be entirely removed with surgery or when the tumor is in a location that is not safely accessible.

Side effects of radiation therapy may include headaches, memory loss, fatigue, and scalp reactions.

Chemotherapy

Chemotherapy uses chemicals that intentionally damage the body’s cells with the expectation that healthy cells can more easily recover from the damage than tumor cells can. Chemotherapy is not often used to treat a meningioma, but it may be recommended for tumors that can’t be treated effectively with surgery or radiation.

How Does Meningioma Progress?

The prognosis for a person with a meningioma depends on several factors. Most people with a non-malignant meningioma (84%) survive at least ten years after treatment, as do most people with a malignant meningioma (62%). In general, survival rates for meningiomas of the spine are better than those of meningiomas of the brain.

Some factors that impact the prognosis include:

• Age. People diagnosed at a younger age generally have better outcomes than those diagnosed later.
• Surgical effectiveness. Survival rates are better for those whose meningiomas can be removed entirely with surgery.

How Is Meningioma Prevented?

There is no clear way to prevent a meningioma from occurring. Even the lifestyle changes that can decrease the risk of many other types of cancer, such as quitting smoking or maintaining a healthy weight, may not reduce the chance of developing a brain tumor.

The only widely accepted preventative measure for brain tumors is the avoidance of high doses of radiation to the head.

Meningioma Caregiver Tips

Caring for someone with a brain tumor can be even more challenging than the already high demands of caring for someone with any other type of severe and progressive illness. Along with the physical changes that make other cancers and serious illnesses so physically and emotionally exhausting to deal with, brain tumors also often produce psychological and cognitive changes in the patient that can threaten the caregiver’s well-being.

As you care for your loved one through the progressive stages of their illness, keep these tips in mind:

• Learn as much as possible about the potential effects of your loved one’s specific type of brain tumor. This will allow you to understand how the illness affects the sufferer’s behavior.
• Get help from your friends and family. Caring for a brain tumor patient is a huge task, and you shouldn’t try to do it alone.
• Take time whenever possible to step away from the patient and the illness and find time for yourself. Acknowledge that it is normal and acceptable to need occasional relief from caregiving burdens.
• Find a support group. It can be beneficial to learn that you are not alone and that other people understand what you are going through.

Many people with meningiomas also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with these tumors:

• People with brain tumors often experience depression or anxiety.
• Personality changes resembling bipolar disorder are sometimes an indication of a brain tumor.

Meningioma Brain Science

Symptoms of meningiomas may vary depending on the location of the tumor. Some types of meningioma and their corresponding common symptoms include:

• Parasagittal/Falx Meningioma. This type of tumor is located in the membrane that separates the two halves of the brain. It can cause weakness in the arms or legs, seizures, or problems with memory and reasoning.
• Cerebral Convexity Meningioma. This type is located in the membrane over the upper surface of the brain. It can cause seizures, headaches, and other neurological symptoms.
• Sphenoid Meningioma. This type is located behind the eyes. It may cause seizures, vision problems, or numbness in the face.
• Olfactory Groove Meningioma. These tumors are located between the nose and the brain. They can cause problems with the senses of smell and vision.
• Suprasellar Meningioma. This type is located near the center of the brain. It can also cause vision problems.
• Posterior Fossa Meningioma. This type is located at the back of the brain. It may cause hearing loss or problems with coordination.
• Intraventricular Meningioma. This type is located in the cavities deep within the brain. It can cause a buildup of cerebral spinal fluid (CSF), leading to hydrocephalus. Headaches, dizziness, or problems with mental functioning can result.
• Intraorbital Meningioma. This type is located near the eye sockets and can cause fluid buildup in the eyes.

Meningioma Research

Title: An Open-Label Phase II Study of Nivolumab in Adult Participants With Recurrent High-Grade Meningioma

Stage: Recruiting

Principal investigator: David A. Reardon, MD

Dana-Farber Cancer Institute

Boston, MA

This research study studies targeted immunotherapies as a possible treatment for recurrent meningioma. The study interventions involved in this study are nivolumab and ipilimumab.

This research is a Phase II clinical trial, which means it will test the safety and effectiveness of nivolumab alone (Cohort 1) or in combination with ipilimumab (Cohort 2). Both nivolumab and ipilimumab are antibodies (types of human protein) that work to stop tumor cells from growing and multiplying by immunotherapy. Immunotherapy is trying to have the body’s immune system work against tumor cells.

Nivolumab and ipilimumab have been used in other research studies, and information from those other research studies suggests that these interventions may help stop meningioma cells from growing.

Nivolumab is FDA-approved to treat other types of cancers, but the FDA (the U.S. Food and Drug Administration) has not yet approved this intervention for this type of cancer. The FDA has not approved the combination of nivolumab and ipilimumab for your specific disease, but it has been approved for other uses.

Title: A Trial of Increased Dose Intensity Modulated Proton Therapy (IMPT) for High-Grade Meningiomas

Stage: Recruiting

Principal investigator: Helen A. Shih, MD

Massachusetts General Hospital

Boston, MA

This research study is studying radiation therapy as a possible treatment for meningioma or a tumor on the lining of the brain. The study drug or intervention involved in this research study is Intensity Modulated Proton Therapy (IMPT).

This is a Phase I/II clinical trial. Researchers are trying to find out if using increased-dose intensity-modulated proton therapy (IMPT) for the treatment of meningiomas will be more effective than the current treatment.

The intensity-modulated part of IMPT allows for an even better concentration of the radiation dose to the desired target and less dosage to the surrounding normal tissues than even traditional passive scattering proton therapy can do. Proton beams can be regulated to stop within or shortly beyond treatment targets. Therefore there is little exposure of the normal tissue to radiation.

The FDA (the U.S. Food and Drug Administration) has not approved IMPT as a treatment for any disease.

Title: Cognitive Status After Removal of Skull Base Meningioma

Stage: Recruiting

Principal investigator: Daniel Prevedello, MD

Ohio State University Wexner Medical Center

Columbus, OH

This prospectively enrolling trial aims to assess long-term cognitive outcomes of patients undergoing surgery for resection of a meningioma associated with the frontal and temporal lobes.

This study will examine patients undergoing resection of a skull-based meningioma, located in the frontal or temporal lobe, via craniotomy or endoscopic endonasal approach. The study will compare cognitive function at baseline, six weeks postoperatively, and one year postoperatively. The cognitive testing being done at baseline will be a clinical care set of assessments done by the speech-language pathology team and will include the RBANS tests, the MoCA, PROMIS-29, and NeuroQOL-Cognitive Functions.