Brain Surgery Recovery – Information On Meningiomas

(Written from the view of the patient)

Information On Meningiomas

Meningioma is usually a slow-growing tumor that forms on the surface of the brain. The spinal column and brain make up the central nervous system, which controls many of the vital functions of the body such as movements, senses, and thought processes.

Usually healthy cells change and grow out of control, often forming a mass. A tumor can be cancerous or benign. A benign tumor can grow but will usually not spread. A Meningioma may cause significant symptoms if it grows and presses on the brain or spinal cord. It starts in the meningeal tissues, which are thin membranes that surround the brain and spinal cord. There are 3 meningeal layers:

  • The dura mater.
  • Arachnoid.
  • Pia mater.

The meninges protect the brain and spinal cord and help the cerebrospinal fluid circulate between the arachnoid and pia layers.

Around 80% of meningiomas are benign. The remaining 20% are either called atypical because they have an increased risk of returning after treatment or, rarely, malignant. Malignant meningioma may be called anaplastic.

The different types of meningioma are:

  • Sphenoid meningioma – The sphenoidal ridge is located behind the eyes. This type makes up 20% of meningiomas. Symptoms of sphenoid meningioma:
    • Loss of feeling or numbness in the face
    • Loss of patches of sight within the field of vision, blindness, double vision
    • Headaches
  • Olfactory groove meningioma – This type of meningioma occurs near the nerves that connect the brain to the nose. It makes up 10% of meningiomas. Symptoms of olfactory groove meningioma:
    • Loss of smell
    • Loss of patches of sight within the field of vision, blindness, double vision
    • Headaches
  • Posterior fossa meningioma – Posterior fossa meningioma develops at the back of the brain. It makes up 10% of all meningiomas. Symptoms of posterior fossa meningioma:
    • Sharp pains in the face, facial numbness, and spasms of the facial muscles
    • Loss of hearing
    • Difficulty swallowing
    • Trouble walking
  • Intra-orbital meningioma – This type of meningioma develops in or around the eye sockets. It accounts for less than 10% of meningiomas. Symptoms of intra-orbital meningioma:
    • Bulging of the eye
    • Loss of vision
  • Falx and parasagittal meningioma – The falx is a membrane that sits in a groove between the left and right sides of the brain. It contains a large blood vessel and protects the brain. Parasagittal meningioma occurs at the top of the falx just on the inside of the skull. These are the most common types of meningioma and make up about 25% of all meningiomas. Symptoms of falx and parasagittal meningioma:
    • Leg weakness
    • Headaches
    • Seizures
  • Convexity meningioma – This type of meningioma occurs on the outer surface of the brain. It makes up about 20% of meningiomas. Symptoms of convexity meningioma:
    • Seizures
    • Headaches
    • Personality or memory changes
  • Suprasellar meningioma – Suprasellar meningioma occurs next to the sella turcica. This is an area at the base of the skull in the center of the skull where the pituitary gland sits. This type makes up 10% of all meningiomas. Symptoms of suprasellar meningioma:
    • Swelling of the optic disk, which is in the retina of the eye where nerve fibers come together to form part of the optic nerve.
    • Loss of patches of sight within the field of vision, blindness, double vision.
  • Spinal meningioma – Spinal meningioma usually occurs in the spine at chest level and may push against the spinal cord. It can cause pain radiating around the chest wall, bladder trouble, or weakness or numbness in the legs. This type makes up less than 10% of all meningiomas. Symptoms of spinal meningioma:
    • Back pain
    • Pain in the limbs or chest
    • Numbness and weakness or the arms and/or legs
    • Difficulties with bodily functions of the bowel or bladder
  • Intraventricular meningioma – Intraventricular meningioma occurs in the chambers that carry fluid throughout the brain. This type makes up about 2% of all meningiomas. Symptoms of intraventricular meningioma:
    • Personality or memory changes
    • Headaches
    • Dizziness

Some general symptoms to look out for regarding a tumor pressing on the brain or spinal cord:

  1. Headaches, which may be severe and may worsen with activity or in the early morning.
  2. Personality or memory changes.
  3. Nausea or vomiting.
  4. Blurred vision.
  5. Seizures.
  6. Sensory – Change in sensation, vision, smell, and/or hearing without losing consciousness.
  7. Complex partial – May cause a loss of awareness or a partial or total loss of consciousness.

Symptoms of meningioma can be caused by:

  • A tumor pressing on the brain or spinal cord, stopping the normal functioning of a specific part of the brain.
  • A tumor pressing on nearby nerves or blood vessels.
  • If the meningioma involves nearby bone, it may cause the bone to expand.

In general, a meningioma is classified into 1 of 3 grades:

  • A grade I tumor grows slowly.
  • A grade II tumor grows more quickly and is often called atypical meningioma.
  • A grade III tumor grows and spreads very quickly and is often called anaplastic or malignant meningioma.

The risk factor of developing a meningioma tumor are:

  • Age – Meningioma is most common in adults age 65 or older, but it can occur at any age. Meningioma is rare in children.
  • Gender – Women are about twice as likely as men to develop noncancerous meningioma. However, men and women are equally likely to be diagnosed with cancerous meningioma.
  • Radiation exposure – Radiation to the head may increase a person’s risk of developing meningioma. Common sources of radiation that can cause meningioma include accidental exposure to radiation and radiation therapy as a treatment for ringworm on the scalp, called tinea capitis.
  • Genetic disorders – People with a hereditary syndrome called neurofibromatosis type 2 (NF2) have a higher risk of developing meningioma. People with NF2 are also more likely to develop cancerous meningioma or more than 1 meningioma.

Some physical side effects from treatment:

  • Steroids – Most people with a brain tumor will need steroids to help relieve swelling of the brain. You will most likely receive steroids when you are first diagnosed, before and after surgery, before and after radiation therapy, and if you have an advanced brain tumor. Steroids may cause:
    • stomach irritation
    • weight gain
    • increased appetite
    • water retention
    • difficulty sleeping
    • changes in mood
  • Anti-seizure medication – A person with a CNS tumor may experience seizures. This type of medication helps to control how often a person has seizures.
  • Shunt – If fluid begins to build up in the brain, a surgeon may need to place a device called a shunt to bypass or move the fluid or drain the excess fluid.
  • Antidepressant medication – Depression can be common in people with a CNS tumor, but it is often undiagnosed. However, not all people with a CNS tumor are depressed.

It is important for the patient of tracking side effects – we will cover more about this at a later stage.

Remission and chance of recurrence

A remission is when the tumor cannot be detected in the body and there are no symptoms. It may be temporary or permanent.

If the tumor returns after the original treatment, it is called a recurrent tumor. It may come back:

  • Local recurrence – In the same place
  • Regional recurrence – Nearby
  • Distant recurrence – In another place

The most common treatment for recurrent meningioma is:

  • Additional surgery.
  • If surgery cannot be done, radiation therapy is generally used.
  • What is also quite helpful is to still receive care to manage the symptoms caused by the tumor. Symptom management is always important because the symptoms of meningioma can interfere with a person’s quality of life.

People with a recurrent tumor often experience emotions such as disbelief or fear. They are encouraged to talk with the health care team about these feelings and ask about support services to help you cope.

Recovery from meningioma is not always possible. If the tumor cannot be cured or controlled, the disease may be called advanced or terminal. This diagnosis is stressful, and for many people, advanced meningioma is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced disease and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. Hospice care options include:

  • Hospice care at home.
  • Hospice center.
  • Nursing care and special equipment can make staying at home a workable option for many families.