Meningiomas

Treatment

Treatment of a brain tumor at Mayo Clinic is a team process. Specialists from the brain tumor treatment team work together to provide the high-quality, integrated care for which Mayo Clinic is known. Generally, a neurologist who has expertise and additional training in neuro-oncology, will coordinate the care team. In addition, the neuro-oncologist will counsel the patient about neurologic issues.

Multiple meningiomas

Enlarge

Because new treatments continually develop, several options may be available for patients at different points in their treatment. The pros and cons of each option are discussed in detail during treatment planning. Mayo Clinic's goal is to improve the duration and quality of survival. Every effort is made to tailor the treatment program to the needs of the patient and family.

Treatment Options

Many patients with meningioma have no symptoms. For these patients, carefully watching the tumor is often appropriate. Evidence from studies which track patients for many years suggest that as many as two-thirds will not have symptoms over time. If the tumor is pressing on surrounding tissue, with or without symptoms, the treatment of choice is usually to surgically remove the tumor (resection).

Initial Treatment Steps

• Steroid medications may be needed to reduce swelling and inflammation of brain tissue.
• Anticonvulsant medications may be prescribed to help control seizures.
• A shunt may be inserted if the tumor has resulted in a buildup of fluid in the brain (hydrocephalus). A shunt is a long, thin tube that is placed in the brain and then threaded under the skin to another part of the body, usually the abdomen. The tube allows excess fluid from the brain to drain into the abdominal cavity where it is reabsorbed.

Several treatment options are available to reduce or remove the tumor.

Surgery

Surgery is usually the first approach. Because meningiomas tend to have well-defined edges and do not invade the brain, complete removal is sometimes possible. The standard treatment is to remove the tumor, the portion of the lining of the brain or spinal cord where it is attached and any bone involved.

However, many tumors are at the base of the brain near cranial nerves and blood vessels. Surgery to remove these tumors is more complicated because of the risk of damaging the nerves and blood vessels. Complete surgical removal is sometimes not possible.

Mayo's neurosurgeons are skilled and experienced in the use of computer-assisted brain surgery, which allows surgeons to precisely map the brain and more accurately and aggressively treat brain tumors.

Even with removal, meningiomas are not always cured. After what appears to be total removal of the tumor, the recurrence rate varies from 10 to 20 percent (measured over 10 years). When the entire tumor is not removed, the recurrence rate is higher.

For patients with large meningiomas at the base of the skull, radiosurgery can be part of a staged approach with neurosurgery. For example, a large part of the tumor can be removed using neurosurgery without affecting the part of the tumor that involves the cranial nerves or blood vessels. Radiosurgery can then be performed for the small remaining tumor with less risk of damaging cranial nerves.

In cases where surgery is too risky, external beam radiotherapy or stereotactic radiosurgery can be extremely useful for tumor control. In a Mayo Clinic study that compared tumor control rates after surgical resection or radiosurgery for patients with small-to medium-sized intracranial meningiomas without symptoms, radiosurgery achieved better tumor control (98 versus 88 percent) with fewer complications (10 versus 22 percent) than surgical resection.

Chemotherapy and Other Drug Therapy

Chemotherapy has not been shown to be effective for meningiomas. However, in instances where surgery and further radiation are no longer feasible or safe, Mayo physicians may recommend possible chemotherapy options.

Clinical Trials

Mayo Clinic participates in numerous clinical trials for brain and nervous system tumors, including trials originating at Mayo Clinic and those sponsored by the National Cancer Institute through the North Central Cancer Treatment Group (NCCTG).