Outlook for Patients With Meningioma

Getting diagnosed with a brain tumor such as a meningioma can feel devastating. You may find yourself grappling with many questions, mostly about what the future holds. "Is this condition treatable? How will it change my life? What can I do to manage and get the best care?" These are just some of the many questions that may start naturally racing through your mind. 

A meningioma is one of the most prevalent primary brain tumors, and a diagnosis showing that you have one can be worrisome without having answers. Here is a comprehensive guide to answer your questions regarding your outlook if you are diagnosed with a meningioma.

Fortunately, the survival rate for people diagnosed with meningioma is relatively high. However, it is worth noting that the survival rate depends on factors such as the type of meningioma and the patient's age. 

Other factors that can affect an individual’s prognosis include: 

• The tumor’s location 
• Other characteristics of the tumor
• The patient’s general health 
• How they respond to the treatment 

Most meningiomas are benign and not cancerous, but rarely, they can be cancerous. Therefore, it is important to have an idea about the type of your tumor. This information is possible via the biopsy of your tumor during its surgical removal.

The 5-year survival rates for non-cancerous meningiomas are at least 95% among children aged 14-years-old and below, at least 91% among people aged between 15-39-years-old, and 87% among adults aged 40-years-old and above. 

The 5-year and 10-year survival rates for people diagnosed with cancerous meningiomas are at least 66% and 59%, respectively. More precisely, the 5-year survival rate among children aged 14-years-old and below is at least 77%. The rate increases to at least 81% among people aged between 15-years-old and 39-years-old but falls to at least 65% among people aged 40-years-old and above.

It is worth noting that although these are survival rates based on periods of five and ten years, many people diagnosed with meningioma may go on to live for decades. More importantly, these are the survival rates for people who may have not undergone treatment for their meningioma – the survival rates increase dramatically after successful treatment. 

The outlook on living with a meningioma brain tumor diagnosis or treatment is mostly positive for these main reasons: 

• Only about 1% of meningiomas are cancerous
• Meningiomas grow very slowly compared to other tumors

In general, benign tumors tend to pose a significantly lower threat to your health compared to malignant tumors such as aggressive gliomas. One of the few situations in which a benign meningioma could pose a significant health risk is if it were growing next to a vital structure. For example, a meningioma growing next to a critical blood vessel may not be successfully amenable to complete surgical removal, and therefore, recurrence is possible.

Fortunately, meningiomas grow more slowly compared to other tumors – some may not grow big enough to pose a health risk for patients living with a meningioma brain tumor. Most importantly, meningiomas are treatable and manageable through surgery and focused radiation therapy. 

As such, meningioma's effects on your health and the quality of your life can be minimal. Often times you can go on with different aspects of your life without any disruptions. Many times you can continue working, driving places, participating in social events, and doing everything else you were doing before and after the diagnosis or treatment. An experienced neurosurgeon can make a substantial difference in your outcome with a complete and safe procedure and, consequently, minimal side effects after meningioma surgery.

Surgery is the most efficient treatment option for meningioma. Ideally, surgery is done to:

1. Remove the tumor and relieve the symptoms caused by the pressure of the tumor on the brain.
2. Completely remove the tumor to minimize the risk of future meningioma recurrence.

However, surgery may rarely cause several side effects, most notably:  

• Difficulty speaking 
• Impaired vision
• Lack of balance and loss of coordination
• Short-term or long-term memory loss
• Seizures
• Stroke

Fortunately, many of these side effects are very rare. It is also worth noting that most of these side effects are temporary and can be treated and managed through rehabilitation therapy and other solutions after surgery. The chance of permanent side effects is small, so you can remain hopeful for full and fruitful years even after living with meningioma.

Your neurosurgeon performing the procedure will try to remove as much of the meningioma as safely as possible. However, it is critical to avoid damaging healthy tissue when operating around vital structures. This may require small residual amounts of the tumor being left behind on the vital brain structures to be treated later with radiation therapy.

In the cases where some small tumor has been left behind, the likelihood that the residual meningioma will recur within 15 years may be as low as 24% or as high as 32%. Several factors influence the likelihood of the meningioma recurring, including: 

• The grade of the meningioma (how aggressive the tumor is and how fast it grows)
• The size of the tumor left behind after surgery
• The original tumor's location

Ninety-five percent of recurring meningiomas grow in the same spot as the original tumor. While most meningiomas recur within 10-20 years after treatment, it is still recommended to follow up with your neurosurgeon routinely with new MRIs (every 1-2 years after complete tumor resection) to detect signs and symptoms of recurrence as early as possible. 

Meningiomas grow at a much slower pace than other brain tumors, and they can go undetected and untreated for decades without major symptoms. Because of their slow rate of growth, these tumors usually achieve a large size before they are detected.

A small asymptomatic meningioma can be observed periodically with imaging without a need for surgery. Therefore, the presence of an incidental meningioma does not mean you need to have surgery.

However, meningiomas can grow to dangerous sizes over time and cause serious health issues depending on their location. Rarely, the growth rate of the tumor may be unpredictable despite its benign nature.

Most notably, meningiomas located close to vital structures within the brain and spinal cord can cause serious symptoms when they start pressing against them. For example, a meningioma growing next to the optic nerve can cause vision impairment when it starts pressing against the nerve. 

So, when should a meningioma be removed?

1. A sizeable meningioma that is causing symptoms (the symptoms can be clearly related to the tumor and not just causing headaches).
2. An asymptomatic meningioma that was being observed and has started growing.

The most prudent course of action is to monitor the tumor through regular imaging – your neurosurgeon will advise you on an evidence-based treatment strategy.

Treatment for meningiomas is tailored to a patient’s tumor type and specific case, but it will likely involve a combination of the following:

Not all meningiomas will require surgical removal. Your healthcare provider may recommend observing the tumor over some time if: 

• It is small, and you are not experiencing any symptoms 
• You have mild or few symptoms, and there is little or no swelling in the brain areas surrounding the tumor 
• You have mild or few symptoms and a long history of tumors without significant impact on your quality of life 
• You are older and have slow-progressing symptoms 
• Surgical intervention carries a considerable risk

Your doctor will ask you to come back for follow-up MRI scans and regular examinations to monitor the tumor’s size and symptoms.

In many cases, meningiomas are benign tumors with defined and marginated borders, allowing for complete surgical removal. This is often done through a craniotomy, where the neurosurgeon opens the skull to access the tumor. The goal is total removal or gross total resection, as it offers the best chance for a cure. 

However, while neurosurgeons will strive to remove the tumor completely (this includes the fibers attaching it to the coverings of the brain and bone), the priority is still maximum, safe removal. The possibility of completely removing a tumor can be affected by factors such as the following: 

• The tumor’s location 
• The tumor’s connection to any brain tissue or surrounding veins 
• Other general factors affecting the safety of surgery    

Radiation therapy makes use of strong beams of energy (radiation) to prevent the growth of meningioma cells. It may be an option if the tumor cannot be fully removed or treated effectively through surgery. It is also helpful in treating some cases of benign meningiomas. 

Chemotherapy makes use of drugs to fight against tumor cells, but it is rarely used in treating meningiomas. Nevertheless, it is generally recommended for patients with recurrent or progressive meningiomas when surgery or radiation therapy is no longer effective.

Bevacizumab is one type of chemotherapy that has shown successful results in treating tumor recurrence after surgery and radiation therapy in patients with anaplastic meningiomas.

A meningioma is as serious of a condition as is any other brain tumor. However, most meningiomas are non-cancerous and tend to grow very slowly. More importantly, people diagnosed with meningioma have a high survival rate, and most meningiomas are treatable and manageable. 

As such, try not to let worrying about the condition consume your life if you are diagnosed with a meningioma. The most prudent thing to do is to seek the advice of an experienced neurosurgeon.

• American Association of Neurological Surgeons 
• National Cancer Institute 
• American Brain Tumor Society 
• National Brain Tumor Society