Meningioma

Disease Description (Causes and Symptoms)

• Definition: Meningioma is a tumor arising from the meninges surrounding the brain and spinal cord. Most are histologically benign tumors that grow slowly, but some show atypical or malignant features.
• Causes·Pathophysiology:
  • Most occur spontaneously, while some are associated with genetic predisposition (e.g., related to neurofibromatosis type 2 [NF2]).
  • Risk factors: A history of radiation exposure to the head and a history of breast cancer have been reported; loss of chromosome 22 (NF2 gene abnormality) is associated.
  • Pregnancy and hormonal changes may affect tumor growth.
  • Histologically, these tumors originate from the meninges (particularly arachnoid cells) and grow slowly, but they may invade the surrounding dura mater, bone tissue, or brain parenchyma, or involve areas around blood vessels.
• Main symptoms:
  • Symptoms vary depending on the location, but typically include gradually developing headaches, seizures (epilepsy), focal neurological deficits (language impairment, motor or sensory impairment), decreased vision or double vision, and personality or behavioral changes
  • Symptoms may appear late depending on the tumor size and location

Treatment Methods (Including Standard Treatment·Medication·Procedures/Surgery·Lifestyle Management) and Precautions

• Diagnostic tests: After a neurological examination, brain CT/MRI (including contrast-enhanced imaging); cerebral angiography and preoperative embolization may be considered when necessary
• Treatment options (determined based on the patient’s condition, tumor location and size, and pathological findings):
  1. Observation
     • Regular MRI follow-up for small, asymptomatic meningiomas or patients at high risk from surgery
     • The follow-up interval and criteria for intervention are determined based on the tumor growth rate and whether symptoms develop
  2. Surgical removal
     • When complete resection of a benign meningioma is possible, it is the only method expected to achieve a cure
     • Even after complete removal, the reported 10-year recurrence rate is approximately 9–29%, so there is a risk of recurrence
     • The extent of surgery (whether complete resection is possible) may be limited depending on the anatomical location (e.g., the cavernous sinus or proximity to major blood vessels) and the degree of invasion
     • Preoperative embolization may be performed to block the tumor’s blood vessels and reduce bleeding
  3. Radiation therapy
     • Gamma Knife·CyberKnife (stereotactic radiosurgery) or external-beam radiation therapy may be used to treat small tumors, inoperable lesions, residual or recurrent lesions after surgery, and malignant or multiple lesions
  4. Anticancer chemotherapy
     • Its effectiveness is limited and it is mainly considered for recurrent or malignant cases that cannot be controlled with surgery or radiation
• Medication treatment (adjunctive)
  • If seizures occur, anticonvulsants (e.g., levetiracetam) are used to control seizures
  • Steroids (e.g., dexamethasone) are used to relieve symptoms caused by edema around the tumor
  • Pain and headaches are treated symptomatically according to the symptoms
• Lifestyle management and precautions
  • If there is a history of seizures, follow the doctor’s instructions regarding restrictions on safety-related activities such as driving and operating machinery
  • If planning a pregnancy, consult a specialist about the tumor’s hormone sensitivity and the timing of treatment (surgery·radiation)
  • If there is a history of radiation exposure, regular follow-up is necessary
• Risk of complications
  • Surgery-related neurological deficits, bleeding, infection, venous thrombosis, postoperative cerebral edema, and increased seizures, among others
  • Possible neurotoxicity/radiation encephalopathy after radiation

Checklist Before an Outpatient Visit (Including Example Questions)

• Items to prepare
  • A list of all medications currently being taken (prescription medications·OTC medications·supplements), including the dose and frequency
  • A history of previous surgeries·hospitalizations·radiation therapy (especially a history of radiation to the head)
  • Existing test results (previous CT/MRI images or radiology reports, blood test results, etc.)
  • Record of symptom changes: when symptoms began·patterns of worsening·whether seizures have occurred·the nature of headaches·changes in vision, sensation, or movement
  • Possibility of pregnancy or pregnancy plans (female patients)
• Materials to show the doctor during the outpatient visit
  • Previous images (if possible, the original CD or radiology report)
  • Symptom diary (especially the frequency and circumstances of seizures·visual changes)
• Things to check before the appointment
  • Whether there have been any recent seizures and whether emergency treatment was provided during a seizure
  • Whether anticoagulants are being taken (important if surgery is being considered)
  • A history of contrast-agent allergy or the status of kidney function (before contrast-enhanced MRI/CT)

General Example Questions to Ask the Doctor

• "Given my condition, do I need treatment right away, or is observation possible?"
• "What are the goals of surgery and its expected benefits and risks (possible complications)?"
• "Why do you recommend radiation therapy (or Gamma Knife), and what effects can be expected?"
• "What medication should I take for seizure management, and for how long?"
• "What are the long-term prognosis and likelihood of recurrence after surgery?"

Examples of Disease-Specific Questions

• "Is complete resection possible because of the location of my tumor? What neurological deficits could occur during surgery?"
• "If I am planning a pregnancy, how might pregnancy affect tumor growth, and what management (follow-up·treatment) options are available during pregnancy?"

Additional information: A specialized diagnosis and treatment plan are determined based on an in-person evaluation by a neurosurgical specialist, imaging findings, and pathological results.