Meningiomas are tumors that arise from the meninges, the membranes surrounding the brain and spinal cord. They are usually benign and slow-growing, pressing on brain tissue and causing symptoms like headache. Meningiomas account for about 34% of all primary brain tumors and occur more often in older adults and women. While surgery is often the first treatment, some meningiomas require radiation or other therapies like anti-seizure medications, steroids, or targeted molecular agents depending on their characteristics and response to initial treatment.

1. MENINGIOMAS
Ms Nisha Mathew

2. INTRODUCTION
 Although meningiomas are considered a type of primary
brain tumor
 They do not grow from brain tissue instead arise from
the meninges
 3 thin layers of tissue covering the brain and spinal cord.
 These tumors most commonly grow inward causing
pressure on the brain or spinal cord
 they may also grow outward toward the skull, causing it
to thicken
 Most meningiomas are benign, slow-growing tumors
 Some contain cysts (sacs of fluid), calcifications
(mineral deposits), or tightly packed bunches of blood
vessels

3. MENINGES
These are the membranes that envelop the brain
and spinal cord of the central nervous system.
It consist of three layers: the dura mater, the
arachnoid mater , and the pia mater.
The primary function of the meninges is to protect
the central nervous
system.

4. NAMING
One system names meningiomas by the type of cells
in the tumor:
 Syncytial (or meningothelial) meningiomas are the
most common and feature unusually plump cells
 Fibroblastic meningiomas feature long, thin shaped
cells
 Transitional meningiomas contain both types of
cells.

5. Another system uses the terms benign, atypical and
malignant (or anaplastic) to describe the overall
grade of meningiomas.
 Benign meningiomas: easily recognized, well-
differentiated cell & grow slowly.
 Atypical tumors : proliferating cells, faster growing &
may grow back after treatment.
 Malignant or “anaplastic” : poorly differentiated cells
that recur rapidly.

6. INCIDENCE
 Meningiomas account for about 34% of all primary
brain tumors.
 They are likely to be diagnosed in adults older than
60 years of age.
 The incidence appears to increase with age
 Meningiomas are rarely found in children
 They occur about twice as often in women as in
men.

7. CAUSES
 Presence of an abnormal chromosome 22.
 Extra copies of platelet-derived growth factor
(PDFGR) and epidermal growth factor receptors
(EGFR)
 Previous radiation to the head
 History of breast cancer
 Neurofibromatosis type 2

8. SYMPTOMS
 Meningiomas they may grow to a large size before
causing symptoms.
 These tumors are most often found in the coverings of
the parasagittal/falcine region (near the top of the brain)
and the convexity (the outer curve) of the brain.
 Other common sites include the sphenoid ridge at the
bottom of the brain, called the skull base.
 As the tumor grows an increased ICP is seen
 Headache and weakness in an arm or leg
 Nausea & Vomiting
 Seizures
 personality change
 visual problems
 Pain and loss of sensation

10. DIAGNOSIS
 Physical examination & clinical history
 neurological examination
 MRI and/or a CT scan.
 MR angiography (a MRI scan of the blood vessels)
 Arteriogram (a blood vessel X ray) to plan
embolization.
 Biopsy

11. TREATMENT
Surgery
 The goals of surgery are to obtain tissue for diagnosis and to remove as much
tumor as possible
 If the tumor cannot be removed, a biopsy to obtain a sample of tumor tissue may
be performed.
 the surgeon may use stereotactic imaging and instrument guiding technologies to
navigate through the brain.
 Occasionally, surgery is performed within a specialized MRI (intraoperative MRI),
which allows the surgeon to view the tumor during the operation and determine the
extent of tumor that is removed
 High powered microscopes may be used to help the surgeon to better see the
tumor.
 Ultrasonic aspirators are used to break up and suction out parts of the tumor.
 In cases where the tumor cannot be removed completely, partial removal can help
decrease symptoms.
 Radiation may then be used to treat the remaining tumor.

13. Radiation Therapy
 Conventional EBRT is given five days a week for
five or six weeks.
 Stereotactic radiosurgery
 Stereotactic radiation therapy

14. Medical treatment
 Anti epileptic drugs
 Cortcosteroids pre & post operatively
 Antiemetics

15. Chemotherapy & Biotherapy
•Alpha interferons & Hydroxyurea
•Targeted molecular agents
• Epidermal growth factor receptor
(EGFR) inhibitors
• Platelet-derived growth factor receptor
(PDGFR) inhibitors
• Vascular endothelial growth factors
(VEGF) inhibitors
• Immunotherapy or the use of biological
agents to stimulate the immune system
Progesterone receptor inhibitors
Somatostatin analogs