Meningiomas are predominantly benign, slow-growing tumors arising from the meninges, most commonly from arachnoid cap cells of the arachnoid mater. The annual incidence is approximately 9 cases per 100,000 population and increases with advancing age. Women are affected more frequently than men, with an approximate female-to-male ratio of 3:2. The typical age at diagnosis is between 50 and 70 years.
Genetic alterations, including monosomy 22, are identified in a substantial proportion of meningiomas. In younger patients in particular, the possibility of an underlying hereditary tumor-predisposition syndrome should therefore be considered. An increased incidence is seen, for example, in neurofibromatosis type 2 (NF2), a genetic disorder also associated with bilateral vestibular schwannomas. Previous radiotherapy is another recognised risk factor.
Meningiomas may exhibit either a nodular, space-occupying growth pattern or a more diffuse, plaque-like configuration. The majority are WHO grade 1 tumors. Approximately 8–10% are atypical meningiomas (WHO grade 2), which have a greater propensity for growth and recurrence, while approximately 2–5% are WHO grade 3 tumors with aggressive biological behavior.
Because meningiomas generally grow slowly and the brain can compensate for gradual mass effect, these tumors may reach a considerable size before becoming clinically apparent. The clinical presentation is determined primarily by tumor location, size, associated edema, and involvement or compression of adjacent neural and vascular structures. Meningiomas may present with seizures, focal neurological deficits, motor weakness, or visual field impairment. Larger lesions or tumors in critical anatomical locations may cause symptoms related to increased intracranial pressure or clinically relevant neurological dysfunction.
| Criterion | Surgery | CyberKnife / ZAP-X |
|---|---|---|
| Tumour size | Medium to large | Small to medium (3-4 cm) |
| Location | Surgically accessible | Any location within the brain |
| Symptoms | Signs of raised intracranial pressure; progressive neurological deficits | Mild or minimal symptoms; no raised intracranial pressure |
| Treatment goal | Tumour removal | Tumour growth control |
| Hospital admission | Required | Not required |
| Treatment duration | Surgery lasting several hours | Approximately 20-30 minutes |
| Return to normal daily activities | Recovery over several weeks | Immediately |
| Long-term tumour control | 90% | 90% |
The risk of recurrence depends on several factors, particularly the extent of surgical resection, WHO grade, tumor biology, and multiplicity.
In contrast to conventional open surgery, treatment with CyberKnife or ZAP-X is performed on an outpatient basis. These non-invasive radiosurgical techniques deliver highly focused radiation with submillimetric accuracy, helping to spare surrounding healthy brain tissue and adjacent critical structures.
General anesthesia is not required. For many appropriately selected meningiomas, a single radiosurgical treatment session is sufficient. Treatment typically takes approximately 10–20 minutes. Larger or anatomically complex meningiomas may require a hypofractionated approach delivered over several treatment sessions. At ERCM, patients have been treated successfully with stereotactic radiosurgery for more than 20 years.
The original ERCM webpage includes a patient-experience video providing insights into the perspectives of patients treated at ERCM, including the considerations that led them to choose their individual treatment pathway together with the center’s specialists.
Most meningiomas are benign intracranial tumors and can generally be treated very effectively when treatment is required. Today, many are discovered incidentally during MRI performed for unrelated symptoms, such as headache. Neurological deficits or seizures are uncommon but may occur when a tumor becomes large, causes significant mass effect, or is located adjacent to
functionally critical brain structures.
Malignant biological behavior is uncommon. The great majority of meningiomas are slow-growing WHO grade 1 tumors and may remain stable for prolonged periods. Higher-grade meningiomas occur much less frequently and are associated with a greater risk of aggressive growth and recurrence.
The term refers to the presence of more than one meningioma, either simultaneously or developing sequentially over time. As with solitary meningiomas, most are benign and can be managed successfully using an individualized strategy based on tumor size, location, growth behavior, and symptoms.
Meningiomas arise from the coverings of the brain or spinal cord. Spontaneous regression is exceedingly rare. However, because many meningiomas grow slowly, there is usually sufficient time to evaluate the clinical course and select the most appropriate individualized management strategy.
The decision depends on tumor type, anatomical location, size, documented growth, and the presence or absence of clinical
symptoms. Small, asymptomatic meningiomas may initially be managed with active surveillance. Larger tumors, growing lesions, or symptomatic meningiomas require individualized consideration of microsurgical resection, fractionated radiotherapy or
stereotactic radiosurgery. Ideally, treatment selection should be made within a multidisciplinary team involving experienced neurosurgeons and radiation oncologists with expertise in stereotactic radiosurgery.
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