Meningiomas are predominantly benign tumors of the brain – similar to acoustic neuromas (vestibular schwannomas). Women are affected more frequently than men, with a ratio of 3:2 [1]. The average age of onset is between 50 and 70 years. But where in the brain are meningiomas located? How are they treated? And when is precision medicine CyberKnife or ZAP-X therapy appropriate? You'll find the answers here.
At ERCM we have extensive radiosurgical experience in meningioma. We often achieve high tumor control with a single therapy session.
However, not every meningioma requires immediate treatment. Growth, location, and symptoms are crucial. Are you affected? Contact us!
Each year, approximately 9 out of 100,000 people develop a new case of meningioma (incidence). The incidence increases with age [1]. As with all other diseases, you as a patient should be fully informed about the disease and the best possible treatment options for you.
For example, the standard treatment of meningiomas involves interdisciplinary coordination between a team of specialists, including neurosurgery, radiosurgery, and radiation therapy experts. In some cases, a combined approach using various therapeutic approaches can be very beneficial.
Here at ERCM, we have already treated over 2,000 patients with cerebral (affecting the brain) and spinal (affecting the spinal canal or spinal cord) meningiomas and have extensive radiosurgical experience with this benign tumor disease.
Important for you: Robot-guided radiosurgery treatment with CyberKnife Therapy or ZAP-X Therapy does not involve complications from fixation or open surgery. This means you can generally continue your daily routine after the treatment and, in most cases, resume your usual activities after your treatment.
Here at ERCM, we have already treated over 2,000 patients with cerebral (affecting the brain) and spinal (affecting the spinal canal or spinal cord) meningiomas and have extensive radiosurgical experience with this benign tumor disease.
Important for you: Robot-guided radiosurgery treatment with CyberKnife Therapy or ZAP-X Therapy does not involve complications from fixation or open surgery. This means you can generally continue your daily routine after the treatment and, in most cases, resume your usual activities after your treatment.
Meningiomas originate from the meninges (arachnoid membrane) [1] . These cover the brain beneath the dura mater. In approximately 85% of cases, meningiomas are benign and grow slowly. They can sometimes calcify. Accompanying thickening of the overlying bone is often observed.
The tumors can exhibit a nodular and space-occupying or flat growth pattern. Only 8 to 10% are atypical (WHO grade 2 with increased growth potential) and 2 to 5% are anaplastic (WHO grade 3, aggressive growth).
27% of all meningiomas exhibit genetic alterations (monosomy 22). Therefore, especially in younger patients, a hereditary cause must always be considered [2]. An increased incidence is seen, for example, in type 2 neurofibromatosis, or NF2 for short – a genetic disorder that can also be the cause of bilateral acoustic neuromas (vestibular schwannomas).
Another risk factor is previous conventional radiation therapy. Pregnancy can also lead to accelerated growth of a meningioma.
According to the World Health Organization (WHO), meningiomas are classified into three levels of aggressiveness:
WHO Grade 1
Grade 1 meningioma is by far the most common. Approximately 85% of all meningiomas are grade 1 tumors, which are benign, slow-growing, and very treatable.
WHO Grade 2
These tumors are characterized by increased growth potential. They account for approximately 8 to 10% of all meningiomas and have a high recurrence rate even after complete surgical removal. Therefore, regular follow-up examinations after treatment are essential.
WHO Grade 3
Grade 3 anaplastic meningiomas are malignant tumors of the meninges with highly aggressive growth. They are extremely rare and account for approximately 2 to 5% of all meningiomas. [Box-END]
Meningiomas can grow anywhere where cells of the arachnoid mater, the middle of the three layers of the meninges, are present. These arachnoid cells are found, for example, between the brain and the skull bones or along the spinal canal.
Most meningiomas (60 to 70%) are located on the cranial cranium (the membrane separating the two cerebral hemispheres), the outer surface of the brain (convexity), and the wing of the sphenoid bone. The sphenoid bone is a bone located in the center of your skull base.
Incidentally, meningiomas are generally rare in the spinal canal.
Due to their slow growth and the brain's ability to adapt, meningiomas can reach considerable size before becoming noticeable. This also means that they may not cause any symptoms for many years, but can grow to a considerable size during this time [1].
The clinical symptoms depend on the location and, consequently, on the compression of the brain tissue. For example, the benign tumor disease can become symptomatic through signs of intracranial pressure or neurological deficits [1]. For example, a convexity meningioma, which may be located in the region of the brain's movement center for arms and legs, can trigger hemiplegia.
Meningiomas can also cause seizures due to brain irritation. Depending on the location and size of the tumor, visual field impairment is also possible.
The initial diagnosis is made using computed tomography (CT) and magnetic resonance imaging (MRI). If necessary, MR angiography—which allows precise visualization of blood vessels—functional MRI and MR spectroscopy (to visualize metabolic processes in tumor tissue), or positron emission tomography (PET) can complement the individual examinations.
Approximately 9% of all patients also have multiple benign tumors. The exact causes of such multiple meningiomas are not always known; in rare cases, they may be associated with genetic factors, meaning they may be hereditary.
Not every meningioma requires immediate treatment. In some cases, the treatment is limited to observation. In others, robot-guided, high-precision treatment with CyberKnife or ZAP-X therapy can be performed.
Whether a meningioma requires treatment can be assessed by a neurosurgeon based on the individual symptoms and the results of imaging studies. In cases of signs of intracranial pressure, for example, surgical treatment is urgently required.
Microsurgery aims to achieve as complete a surgical removal of the benign brain tumor as possible. Repeated tumor removals are possible in cases of incomplete resection or tumor regrowth. In some cases of residual meningioma after surgery, only CT or MRI scans are performed initially, as growth can sometimes be halted for years.
In the case of very vascular tumors, preoperative embolization is possible – a medical term that, in simple terms, means the closure of blood vessels.
The very rare anaplastic meningiomas (WHO grade 3) are treated with additional radiation therapy. Depending on your individual situation, various treatment options will be discussed with you – and combined if necessary.
Chemotherapeutic approaches have not yet demonstrated any clear benefit. Therefore, treatments remain reserved for individual cases and clinical trials.
Even experimental therapeutic approaches using hormone preparations have not yet found their way into regular standard use and have yet to demonstrate their undoubted effectiveness.
If fluid accumulation is found in the adjacent brain tissue around a meningioma (peritumoral edema), causing symptoms, temporary cortisone treatment may be necessary to reduce swelling. This is usually administered before and for a short time after the actual tumor treatment.
If epileptic seizures occur, treatment is initiated with anti-seizure medications. This drug therapy should be continued for some time even after removal of the meningioma under EEG monitoring. EEG stands for electroencephalography – a procedure that measures the electrical activity of the cerebral cortex.
The robot-guided, high-precision treatment with the CyberKnife or ZAP-X, as we perform it here at ERCM, can be used very well as a primary form of therapy for smaller tumors that are difficult to remove surgically (e.g. cavernous sinus, meningioma) [3]. In most cases, we are talking about a single treatment session, through which high tumor control can be achieved. This means that renewed tumor growth is ideally prevented.
An exception is meningiomas, which affect the optical system or include your visual functions. These are usually dealt with in 5 sessions.
There are also cases where a combination of classic surgery and CyberKnife therapy may be required. If, for example, the benign brain tumors are so critically located that complete removal cannot be safely possible.
This video provides insights into the experiences of patients treated at ERCM – including their reasons for choosing to undergo their personal treatment with us and our experts.
Depending on the degree of meningioma removal. Tumor recurrence occurs in approximately 13% of cases after complete resection, and in up to 85% after incomplete resection. In malignant forms of the disease (higher WHO grade) or multiple meningiomas, the incidence of recurrence is significantly higher.
Regardless, regular follow-up imaging examinations are always necessary, which must be assessed by your treating neurosurgeon. Repeat surgical removal of recurrent meningiomas is generally possible.
In cases of unfavorable localizations that again only allow partial removal, concepts of multimodal therapies are used that combine the greatest possible surgical removal and subsequent robot-guided radiosurgical treatment [3].
All individual therapy concepts are discussed in detail with the respective neurosurgical specialists in advance of your treatment, discussed and planned with you.
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Meningiomas are predominantly benign brain tumors and can usually be treated very well and effectively. Today, they are often discovered as an incidental finding during an MRI diagnosis, e.g. in the case of existing headache symptoms. Only in rare cases do they cause symptoms of failure or seizures, e.g. if they are very large or located at a critical point in the brain.
Meningiomas have a very low tendency to develop malignantly. Malignant meningiomas occur only in rare exceptional cases. Most grow slowly or are stable over long periods of time.
These are several meningiomas that occur simultaneously or one after the other. Like individual meningiomas, they are usually benign and can be treated successfully.
Meningiomas occur on the meninges or spinal cords. The spontaneous possibility of regression is extremely rare. Since meningiomas usually grow slowly, there is enough time to choose an individually suitable form of therapy.
This depends on the type, location and size of the mass. In principle, without clinical symptoms, it is possible to wait when the meningioma is still small. In the case of larger foci or a meningioma with clinical symptoms, it is necessary to weigh up between surgery, conventional radiotherapy or radiosurgical treatment. This is best done in an interdisciplinary team with neurosurgeons and specialized radiation oncologists.
[1] Ruge, M., Goldbrunner, R., Grau, S., Management of benign brain tumors: meningioma and vestibular schwannoma. Best Practice Oncology 2019;14:284-292.
https://doi.org/10.1007/s11654-019-0155-5
[2] Seliger, C., Wick, W., Neues zur Einteilung und Therapie von Meningiomas. Neurology up2date 2020;03:343-356.
https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-0965-2007
[3] Ehret, F., Kufeld, M., Fürweger, C., Haidenberger, A., Fichte, S. et al., The Role of Stereotactic Radiosurgery in the Management of Foramen Magnum Meningiomas-A Multicenter Analysis and Review of the Literature. Cancers (Basel) 2022; 14(2):341.
https://www.mdpi.com/2072-6694/14/2/341