Meningioma

Meningiomas arise from the meninges — the protective layers that surround the brain and spinal cord. They are the most common primary brain tumor, and the great majority are benign (WHO Grade I). Most grow slowly. Some grow quickly. A small subset are atypical (Grade II) or anaplastic (Grade III) and behave more aggressively.

Many meningiomas are discovered incidentally — found on a head scan done for an unrelated reason. The presence of a meningioma does not automatically mean it needs treatment. What matters is the size, location, growth rate, and whether it is causing or threatens to cause symptoms.

Imaging is the starting point — contrast-enhanced MRI characterizes the lesion. For small, asymptomatic meningiomas, the right initial move is often observation: a follow-up MRI in six to twelve months to establish a growth rate.

For meningiomas that are growing, causing symptoms, or located where progression would cause significant problems, treatment is considered. The two main options are surgical resection and stereotactic radiosurgery — sometimes both, depending on the case.

Surgical access depends on location. Convexity meningiomas (on the surface of the brain) are usually straightforward to remove. Skull-base meningiomas (around critical nerves, vessels, or the brainstem) require more nuanced planning and sometimes a staged approach. We discuss the trade-offs candidly before any decision.

Surgery is considered for symptomatic meningiomas, for tumors that have grown on serial imaging, for lesions in locations where continued growth would compromise function, or when complete resection is feasible.

The goal is gross-total resection when safe. For tumors near critical structures, a subtotal resection followed by radiosurgery to the residual can be the right balance of safety and durability. Long-term, the recurrence rate depends on how complete the initial resection was, which is why follow-up imaging is essential.