Dr. Ian F. Dunn, BWH Department of Neurosurgery
Author: Ian Dunn, MD, neurosurgeon in the Department of Neurosurgery at Brigham and Women’s Hospital and an Associate Professor of Neurosurgery at Harvard Medical School. Dr. Dunn’s interests include surgery for meningiomas, chordomas and other skull base tumors.
People who have been diagnosed with a common brain tumor known as a meningioma have several treatment options. I recommend that patients and their families carefully evaluate and discuss the risks and benefits of each option with their physician. Other factors that will affect the choice of treatment are a patient’s age, overall state of health, and where the patient will receive treatment.
What is a Meningioma?
A meningioma is a type of tumor that develops from the meninges, the membrane that surrounds the brain and spinal cord. About 85 percent of meningiomas are categorized as benign tumors. Because most benign meningiomas grow slowly, they may reach a relatively large size before causing symptoms, such as headaches, blurred vision, seizures, numbness, weakness in the arms or legs, or speech difficulty.
Meningiomas are one of the most common brain tumors within the general population. They are more common among women and occur with increasing frequency as people get older. Meningiomas are found in about three percent of people over the age of sixty.
There are three treatment options for meningiomas: observation, surgery, and radiation. There are also clinical trials underway to identify new therapies.
Observation versus Surgery
Meningiomas that are smaller in size and are not causing symptoms may be observed by your physician. We commonly perform periodic CT or MRI scans at intervals of six to 12 months and consider medical intervention if growth is observed over time or if symptoms develop.
Surgery and Recovery
Surgery is the primary treatment for meningiomas. The goal of surgery is to remove all of the meningioma and the membranes from which it originates. The location of a meningioma determines the complexity of surgery to remove it. Meningiomas located at the surface of the brain (convexity) are more easily accessed than those at the skull base, those that involve the blood vessels in the brain (sagittal sinus or cavernous sinus), or meningiomas in the optic nerve sheath. Neurosurgeons at Brigham and Women’s Hospital have particular expertise treating meningiomas located in any area of the brain..
Recovery can vary according to the length and type of your surgery. Usually, patients are observed in the neurosurgery intensive care unit (ICU) overnight. The next day, they can expect to be transferred to a regular hospital floor, where they will be walking, eating, and drinking. A common hospital stay is between two to five days. Occasionally, patients may need to recover at a rehabilitation facility prior to returning home.
Once home, patients can expect to be walking and moving around, but they may be more tired than usual in the first seven to 10 days after surgery. Patients may resume normal activities, including driving, as soon as they feel strong enough. Patients should plan on being absent from work for four to eight weeks, depending on the type of surgery.
Radiation is often used in combination with surgery, to more fully treat patients with aggressive types of meningiomas. Newer ways of delivering radiation, such as stereotactic radiosurgery, stereotactic radiotherapy, or intensity-modulated radiotherapy, deliver more focused radiation, minimizing radiation exposure to the normal brain tissue surrounding the tumor. Radiation may be given in one large dose (stereotactic radiosurgery) or in multiple small doses (stereotactic radiotherapy).
Meningioma Clinical Trials
There are no approved drugs for meningioma, although clinical research may lead to drug treatments for patients with recurrent meningiomas.
Researchers at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) are studying the genetic factors related to the growth of meningiomas. By studying our patients’ tumors, we and others have identified important new genes in meningioma growth. Two of these genes have formed the basis of a clinical trial for patients with specific genetic changes in their tumors.
In patients with more aggressive meningiomas, researchers at DF/BWCC are also conducting a clinical trial in which they are studying whether the immune system can be stimulated to kill tumor cells. This has approach has shown great promise in other brain tumor types.
Don’t hesitate to consult your doctor if you need more information about your diagnosis, treatment choices, or anything to do with your meningioma or related health issues.