Meningiomas are benign tumors of the meninges that can compress adjacent brain tissue. Symptoms depend on the tumor's location. Diagnosis is by MRI with contrast agent. Treatment may include excision, stereotactic radiosurgery, and sometimes radiation therapy.

Meningiomas, particularly those < 2 cm in diameter, are among the most common intracranial tumors. Meningiomas are the only brain tumor more common among women. These tumors tend to occur between ages 40 and 60 but can occur during childhood. These benign tumors can develop wherever there is dura, most commonly over the convexities near the venous sinuses, along the base of the skull, and in the posterior fossa and rarely within ventricles. Multiple meningiomas may develop. Meningiomas compress but do not invade brain parenchyma. They can invade and distort adjacent bone. There are many histologic types; all follow a similar clinical course, and some become malignant.

Symptoms and Signs

Symptoms depend on which part of the brain is compressed and thus on the tumor's location (see Table 3: Intracranial and Spinal Tumors: Symptoms of Meningiomas by Site). Midline tumors in the elderly can cause dementia with few other focal neurologic findings.

Table 3
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Symptoms of Meningiomas by Site Site Findings Base of skull Visual loss Oculomotor palsies Exophthalmos Cerebral convexities Focal seizures Cognitive deficits Ultimately, signs of increased intracranial pressure Clivus and apical petrous bone Gait disturbance Limb ataxia Deficits referable to the 5th, 7th, and 8th cranial nerves Foramen magnum Ipsilateral suboccipital pain Paresis that begins in the ipsilateral arm and progresses to the ipsilateral leg, then to the contralateral leg and arm Sometimes Lhermitte sign Cranial nerve deficits (eg, dysphagia, dysarthria, nystagmus, diplopia, facial hypoesthesia) Olfactory groove Anosmia Sometimes papilledema and visual loss Parasagittal or falx Spastic paresis or sensory loss, usually beginning in the contralateral leg, but occasionally bilateral Cognitive deficits Posterior fossa tentorial tumors that extend superiorly or inferiorly Hydrocephalus Sphenoid wing: Medial (growing into the cavernous sinus) Oculomotor palsies Facial numbness Middle (growing anteriorly into the orbit) Visual loss Exophthalmos Lateral (as a globular mass or a meningioma en plaque*) Seizures Headaches Tuberculum sellae Visual loss Bone changes sometimes visible with imaging *Meningioma en plaque involves spread into the dura, with dural thickening and invasion of adjacent bone; the tumor sometimes grows into the temporal bone. Symptoms of Meningiomas by Site Site Findings Base of skull Visual loss Oculomotor palsies Exophthalmos Cerebral convexities Focal seizures Cognitive deficits Ultimately, signs of increased intracranial pressure Clivus and apical petrous bone Gait disturbance Limb ataxia Deficits referable to the 5th, 7th, and 8th cranial nerves Foramen magnum Ipsilateral suboccipital pain Paresis that begins in the ipsilateral arm and progresses to the ipsilateral leg, then to the contralateral leg and arm Sometimes Lhermitte sign Cranial nerve deficits (eg, dysphagia, dysarthria, nystagmus, diplopia, facial hypoesthesia) Olfactory groove Anosmia Sometimes papilledema and visual loss Parasagittal or falx Spastic paresis or sensory loss, usually beginning in the contralateral leg, but occasionally bilateral Cognitive deficits Posterior fossa tentorial tumors that extend superiorly or inferiorly Hydrocephalus Sphenoid wing: Medial (growing into the cavernous sinus) Oculomotor palsies Facial numbness Middle (growing anteriorly into the orbit) Visual loss Exophthalmos Lateral (as a globular mass or a meningioma en plaque*) Seizures Headaches Tuberculum sellae Visual loss Bone changes sometimes visible with imaging *Meningioma en plaque involves spread into the dura, with dural thickening and invasion of adjacent bone; the tumor sometimes grows into the temporal bone.

Diagnosis

• MRI

Diagnosis is similar to that of other brain tumors, usually by MRI with a paramagnetic contrast agent. Bone abnormalities (eg, brain atrophy, hyperostosis around the cerebral convexities, changes in the tuberculum sellae) may be seen incidentally on CT or plain x-rays.

Meningioma, Parasagittal

Treatment

• For symptomatic or enlarging meningiomas, surgical excision or radiation therapy

For asymptomatic small meningiomas, particularly in older adults, monitoring with serial neuroimaging is sufficient.

Symptomatic or enlarging meningiomas should be excised if possible. If they are large, encroach on blood vessels (usually surrounding veins), or are close to critical brain areas (eg, brain stem), surgery may cause more damage than the tumor and is thus deferred.

Stereotactic radiosurgery is used for surgically inaccessible meningiomas and electively for other meningiomas. It is also used when tumor tissue remains after surgical excision or when patients are elderly.

If stereotactic radiosurgery is impossible or if a meningioma recurs, radiation therapy may be useful.

Key Points

• Meningiomas are tumors of the meninges that are usually but not always benign.
• They typically occur between ages 40 and 60 and are more common among women.
• Symptoms vary greatly depending on the location of the tumor.
• Excise symptomatic or enlarging tumors; use stereotactic radiosurgery if tumor remains after excision or cannot be excised completely.

Last full review/revision December 2012 by Roy A. Patchell, MD