| A meningioma is a tumor, generally benign, originating in the fibrous tissue that protects the brain and spinal cord (meninges). This predisposition may be demonstrated through a family history of meningiomas, or through other central nervous system (CNS) conditions such as peripheral neurofibromatosis (von Recklinghausen's disease) or basal cell nevus syndrome (Gorlin syndrome). Head trauma is also believed to increase risk.
Meningioma tumors usually occur singly, although multiple meningiomas may occur. Most are found in the area around the brain and can either occur on or compress the optic nerve or other neurovascular structures. Spinal meningiomas are rare.
Meningiomas are characterized by slow growth and are typically present for years before any symptoms appear. Approximately 2% of routine autopsies reveal the presence of undiagnosed meningiomas less than 2 cm in diameter. Symptoms of meningiomas generally result from compression of the brain or spinal cord, but tumors may also invade bone and cause localized thickening (hyperostosis).
One percent to ten percent of meningiomas are malignant. Malignant meningiomas may invade brain tissue, but metastatic dissemination is rare.Risk: Men are typically diagnosed during middle age. Brain meningioma occurs in a 3:2 female to male ratio; spinal cord meningioma occurs in a 10:1 female to male ratio. Incidence and Prevalence: Meningiomas account for about 20% of primary brain tumors occurring in adults and in 1.2 to 2.6 per 100,000 individuals ("Treatment"; Castillo). |
Source: Medical Disability Advisor
| History: The individual may complain of seizures, recent onset of persistent headaches, and vomiting. Depending on the location of the meningioma, focal neurological deficits may include symptoms such as gait unsteadiness, numbness, vision disturbances, or protrusion of the eye (exophthalmos). Physical exam: The exam may be normal. Eye protrusion may be seen. Occasionally, individuals may develop enlargement of the head due to fluid accumulation within the skull (hydrocephalus). Confusion may be noted in some cases as well as cranial nerve palsy and extremity weakness. Tests: A complete neurological workup using magnetic resonance imaging (MRI) and CT scanning is usually performed to determine size and location of the tumor and its affect on surrounding structures. Chest x-rays and other tests are performed as necessary to determine whether the tumor is secondary to a primary cancer elsewhere that has spread (metastasized) to the brain. Routine laboratory tests will be performed to evaluate the individual's general condition. Motor skills may be tested to determine the influence of the tumor on CNS-mediated functions. An immunohistochemical staining technique known as labeling index staining is sometimes used to identify the type of cells in the tumor and help determine how cells are dividing, which indicates how aggressive the tumor might be. |
Source: Medical Disability Advisor
| Complete surgical removal of the meningioma is the treatment of choice, and often results in long term cure. Endoscopic neurosurgical procedures are used when possible. In some cases, the tumor or some portion of it cannot be removed with an acceptable level of risk because of its size or location. In other cases, the removal of a small accidentally discovered asymptomatic meningioma might be postponed because the risk from the surgery is greater than risk of the tumor affecting the individual's ability to function. In this circumstance, periodic clinical evaluation with MRI is important to monitor tumor growth and the possible impact of the tumor on neurovascular structures. In cases in which recurrence is likely because of the tumor's location or according to the results of staining techniques (labeling index staining) that determine tumor cell type, certain systemic treatments (angiogenesis inhibitors, growth hormone inhibitors) are used to slow down meningioma cell growth. Gene therapy is also being used in some individuals; this therapy may increase as more is learned about genetic origins of meningiomas. |
Source: Medical Disability Advisor
| Most meningiomas can be removed safely and completely with surgical resection. The operative mortality rate is 0.5%, with 5-year survival greater than 90% and a 10% to 20% recurrence rate. One in 3 individuals may be left with residual tumor after surgery, with recurrence rates as high as 30% to 50%. The 5-year recurrence rate for malignant meningioma is 65%. Radiation therapy can be used in managing recurrent tumors. |
Source: Medical Disability Advisor
| Possible complications depend on the size and location of the meningioma, and include seizures, lower extremity weakness (paresis), and urinary incontinence. The pressure of the tumor may cause swelling of the optic nerve (papilledema) and result in loss of vision (blindness). |
Source: Medical Disability Advisor
| After treatment, the prospect for return to work is generally good, but eventual recurrence is a possibility. Individuals who only require surgery may return to their normal duties after an appropriate recuperation period. If post-operative radiation is required, additional leave from work may be needed. Periodic absences may be needed for follow-up examinations and treatment. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has individual complained of seizures, recent onset of severe headaches, or vomiting?
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Does individual have any problems walking?
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Has individual noticed any numbness, vision disturbances, or protrusion of the eyes?
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Does individual have a family history of meningiomas, von Recklinghausen‘s disease, or Gorlin syndrome?
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Is there evidence of hydrocephalus?
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Has individual had a complete neurological work up including CT and MRI?
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Has metastatic carcinoma been ruled out?
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Have conditions with similar symptoms such as meningitis, benign intracranial hypertension, other types of brain tumors, and metastatic cancer been ruled out?
Regarding treatment:
- Has the tumor been surgically removed?
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Is individual experiencing a recurrence of the tumor?
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Will individual have periodic evaluation with MRI to monitor changes in the tumor?
Regarding prognosis:
- Does individual have any conditions such as Alzheimer's disease, seizure disorder, or cardiovascular disease that could impact recovery?
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Did individual have any complications such as seizures, loss of vision, urinary incontinence, or inflammation of the optic nerve (papilledema) that could lengthen disability?
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Source: Medical Disability Advisor
| Castillo, German C. "Meningioma, Brain." eMedicine. Eds. Jeffrey L. Creasy, et al. 6 Aug. 2004. Medscape. 10 Nov. 2004 <http://emedicine.com/radio/topic439.htm>. "Treatment of Meningiomas at Mayo Clinic." MayoClinic.com. 2004. Mayo Foundation for Medical Education and Research. 10 Nov. 2004 <http://www.mayoclinic.org/meningiomas/index.html>. |
Source: Medical Disability Advisor