The Meningioma Initiative at Brigham and Women's Hospital
How can you choose the best treatment option?
Every treatment type has its own set of risks and benefits, and the treatment type has to be tailored to the type and location of each individual meningioma. Other factors that will affect your treatment choice are your age, overall state of health, and which medical center you turn to for treatment.
Patients should fully explore their options. You may find that several doctors will suggest the same treatment options, or you may be faced with different suggestions to choose from. Major medical centers usually offer free or low cost opinions from specialists, and this is an excellent opportunity to weigh your options.
If you want more information about your diagnosis, treatment choices, or anything to do with your meningioma or related issues, don’t hesitate to ask your doctor.
What are the treatment options for meningiomas?
There are generally three treatment options for meningiomas: observation, surgery, and radiation. Medical therapy may be an option in the future.
Observation
A reasonable rule is that asymptomatic meningiomas can be observed for a period of 3 to 12 months before a definitive treatment decision is made.
If a meningioma is small and asymptomatic in a person over 65, it may just be observed. Observation requires annual CT or MRI scans with contrast. Larger tumors, those with symptoms or those that show progressive growth should be treated.
Surgery
Surgery is the primary treatment for meningiomas. Complete removal is the ideal result. However, if the tumor cannot be completely excised, treatments can be combined, and the remainder of the tumor may be treated with radiotherapy.
It is important that surgery is tailored to the size and location of the tumor. Protecting adjacent structures are key surgical considerations when choosing the surgical approach and the extent of resection. Surgery is usually most effective with tumors of the dura, falx, lateral sphenoid wing, frontal base, and cerebellar convexity. Complete resection may not be possible in tumors that involve the sagittal and cavernous sinuses, cerebellopontine angle, clivius, tentorial notch, or optic nerve sheath. As techniques, such as image guided surgery, become more advanced, however, surgeons are having an increased success rate with historically difficult tumors.
In cases where it is necessary to leave significant residual tumor, the goal of surgery has usually been something other than complete removal; such as decompression of the optic nerve to protect vision.
Radiotherapy
Until recently the use of external beam radiotherapy for meningiomas has been controversial because of concerns about long-term neurotoxicity and conflicting evidence regarding efficacy. Several recent studies have been shown to control tumor growth 50% to 90%.
The newer forms of focal radiotherapy (such as radiosurgery, or stereotactic radiotherapy, or intensity modulated radiotherapy) may be as effective as traditional radiotherapy in treating meningiomas without effects on the surrounding brain.
Radiation may have a role in working together with surgery to more fully treat select patients with inoperable, partially resected, and recurrent meningiomas.
One of the traditional limitations of external beam radiation has been radiation to surrounding brain. This limitation is now less because techniques of focused radiation have been developed using the linear accelerator or multiple cobalt sources (the gamma knife) that avoid exposure to the brain outside the target area. Radiation may be given in one large fraction (stereotactic radiosurgery) or in multiple small fractions (stereotactic radiotherapy).
Medical Therapy
The growth of meningiomas is influenced by hormones and growth factors, and that raises the possibility of medical therapy. However, no practical applications have been developed yet.
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