This information is about a specific type of tumour known as a meningioma. It should ideally be read with our general information about brain or spinal cord tumours.

The central nervous system (CNS) is made up of the brain and spinal cord.  Cells in the CNS normally grow in an orderly and controlled way. If for some reason this order is disrupted, the cells continue to divide and form a lump or tumour.

A tumour may be either benign or malignant. Although a benign tumour can continue to grow, the cells do not spread from the original site. In a malignant tumour, the cells can invade and destroy surrounding tissue and may spread to other parts of the brain.

Tumours affecting the CNS are fairly rare. About 4500 new tumours are diagnosed each year in the UK. Many of these are malignant.

A meningioma is a tumour of the meninges, which are the protective membranes around the brain and spinal cord (see figure 1).

A meningioma can start in any part of the brain or spinal cord, but the most common sites are the cerebral hemispheres of the brain, made up of the four lobes (see figure 2).

Most meningiomas are benign. Malignant meningiomas are extremely rare.

Meningiomas make up nearly 1 in 5 of all primary brain tumours. They are most likely to be found in middle-aged or elderly adults. Meningiomas are more common in women than in men.

As with most brain tumours, the cause of a meningioma is unknown. Research is being carried out into possible causes.

Meningiomas are usually slow-growing tumours and the main symptoms arise from increased pressure within the skull (raised intracranial pressure). This may be due to a blockage in the ventricles (fluid-filled spaces of the brain) that leads to a build-up of cerebrospinal fluid (CSF). CSF is the fluid that surrounds and protects the brain and spinal cord. The increased pressure may also be caused by swelling around the tumour itself.

Raised intracranial pressure can cause headaches, sickness (vomiting) and visual problems. Changes in behaviour and personality are general signs of a brain tumour. Epileptic fits can be an early symptom.

Meningiomas can grow in different parts of the brain and symptoms will relate to the area of the brain that is affected:

• A tumour in the frontal lobe of the brain may cause gradual changes in mood and personality. There may also be paralysis (inability to move) on one side of the body (hemiparesis).
• If the left side of the brain is affected, there may be problems with speech, such as slurring or muddling of words.
• A tumour in the temporal lobe of the brain may cause problems with coordination and memory loss.
• If the parietal lobe of the brain is affected, writing and other such activities may be difficult. Hemiparesis may also be present. Fits (seizures) often occur in people with a meningioma.

So that your doctors can plan your treatment, they need to find out as much as possible about the type, position and size of the tumour. This is done through a number of tests and investigations.

Neurological examinations (nerve tests) Usually you will have a neurological examination to assess any effect of the tumour on your nervous system.

CT (computerised tomography) scan A CT scan takes a series of x-rays which build up a three-dimensional picture of the inside of the body. The scan is painless and takes from 10–30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan. A CT scan may be used to identify exactly where the tumour is or to check for any spread of the cancer.

Most people who have a CT scan are given a drink or injection to allow particular areas to be seen more clearly. This may make you feel hot all over. Before having the injection or drink, it is important to tell the person doing this test if you are allergic to iodine or have asthma.

MRI (magnetic resonance imaging) scan This test is similar to a CT scan, but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. During the scan you will be asked to lie very still on a couch inside a long tube for about 30 minutes. It is painless but can be uncomfortable, and some people feel a bit claustrophobic during the scan. It is also noisy, but you will be given earplugs or headphones.

Some people are given an injection of dye into a vein in the arm, but this usually does not cause any discomfort.

Angiogram This test involves an injection of a dye to show up the blood vessels in the brain. The dye is injected through a thin, flexible tube (catheter) that is inserted into an artery in the groin, arm or neck. A series of x-rays are taken. Your nurse or doctor will explain this test to you in more detail.

Biopsy To confirm the exact type of tumour, a sample of cells may be taken from the tumour and examined under a microscope. Your doctor will discuss with you whether this is necessary in your case, and what the operation involves. Meningiomas can usually be clearly shown by scans and so a biopsy is rarely necessary.

The treatment for meningioma depends on a number of things, including your general health and the size and position of the tumour. The results of your tests will enable your doctor to decide on the best type of treatment for you.

Your treatment will usually be planned by a team of specialists known as a multidisciplinary team (MDT). The team will usually include a doctor who operates on the brain (neurosurgeon), a doctor who specialises in treating illnesses of the brain (neurologist), a doctor who specialises in treating cancer (an oncologist), a specialist nurse and possibly other health professionals, such as a physiotherapist or a dietitian.

There are some risks associated with treatment to the brain and your doctor will discuss these with you.

If the pressure in the skull is raised, it is important to reduce it before any treatment is given for brain tumours. Steroid drugs may be used to reduce swelling around the tumour. If the raised pressure is due to a build-up of CSF, a tube (shunt) may have to be inserted to drain off the excess fluid.

Consent

Before you have any treatment, your doctor will give you full information about what the treatment involves and explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent.

Benefits and disadvantages of treatment

Treatment can be given for different reasons and the potential benefits will vary for each person. If you have been offered treatment that aims to cure your cancer, deciding whether to have the treatment may not be difficult. However, if a cure is not possible and the treatment is to control the cancer for a period of time, it may be more difficult to decide whether to go ahead.

If you feel that you can’t make a decision about the treatment when it is first explained to you, you can always ask for more time to decide.

You are free to choose not to have the treatment and the staff can explain what may happen if you do not have it. You don’t have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

Surgery

Where possible, surgery is the main treatment for meningioma and in many cases the tumour can be removed completely with no complications.

Occasionally, the position of a tumour makes it impossible, or too risky, to remove surgically. If surgery is not possible, your doctor will discuss other types of treatment with you.

Radiotherapy

Radiotherapy treatment is the use of high-energy rays to destroy the cancer cells. It may be used after surgery for malignant meningioma to reduce the chance of the tumour coming back. It may be used after surgery for benign meningiomas that cannot be completely removed.

If surgery is not possible, radiotherapy may be used alone. Sometimes a technique known as stereotactic radio-surgery may be used, in which hundreds of beams of radiotherapy are aimed at the tumour in a single session. This is a very accurate treatment and is used mainly for smaller tumours.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy is very rarely used for treating meningioma although research continues into developing this form of treatment.

Recent research has shown a possible link between meningioma and hormone levels. Trials using hormonal drugs to treat this type of tumour are in the early stages.

You may find the idea of a tumour affecting the brain extremely frightening. The brain controls the body, and not being in control is something that can be very worrying. You may experience many different emotions, including anxiety and fear. These are all normal reactions, and are part of the process many people go through in trying to come to terms with their condition.

Many people find it helpful to talk things over with their doctor or nurse, or one of our support service nurses. Close friends and family members can also offer support.

Driving

In some circumstances you may not be allowed to drive for a period of time. If you have had an epileptic fit, the Drivers and Vehicle Licensing Association (DVLA) will not allow you to drive for a year after your last fit. You can then drive again provided you remain well.

If you have a benign meningioma and have not had any seizures, the DVLA requires that you do not drive for at least six months after surgery. Initially, your licence may only be for a short period.

If you drive some vehicles, such as a LGV (large goods vehicle) or a PCV (passenger carrying vehicle) you will not be able to drive for at least five years after surgery. If you have had any seizures you will not be able to drive this type of vehicle until 10 years after your last fit. In some circumstances, it will be permanently recommended that you do not drive these vehicles. You may require a medical assessment before your driving licence is renewed.

The hospital will not contact the DVLA, but it is your responsibility to do so and your doctor will advise you how to do this.

This section has been compiled using information from a number of reliable sources, including:

• Oxford Textbook of Oncology (2nd edition). Souhami et al. Oxford University Press, 2002.
• The Textbook of Uncommon Cancers (2nd edition). Raghavan et al. Wiley, 2006.
• Cancer in the Nervous System (2nd edition). Levin. Oxford University Press, 2002.

For further references, please see the general bibliography.