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Meningiomas

By

Steven A. Goldman

, MD, PhD, University of Rochester Medical Center

Last full review/revision Jan 2021| Content last modified Jan 2021
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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 of Meningiomas

Symptoms of meningiomas depend on which part of the brain is compressed and thus on the tumor’s location (see table Symptoms of Meningiomas by Site). Midline tumors in older people can cause dementia with few other focal neurologic findings.

Table
icon

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 of Meningiomas

  • MRI

Diagnosis of meningiomas 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.

Treatment of Meningiomas

  • 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. In the following cases, surgery may cause more damage than the tumor and is thus deferred:

  • The meningiomas are large.

  • They encroach on blood vessels (usually surrounding veins).

  • They are close to critical brain areas (eg, brain stem).

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 older.

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.

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