Brain and skull base · Condition
Meningioma: Observation, Surgery, and Radiation
A meningioma grows from the meninges, the thin layers that cover the brain and spinal cord. Most meningiomas grow slowly and are not cancer. Treatment depends on the tumor's size, location, growth, and symptoms, and on your health and goals.
At a glance
- Many meningiomas are found by chance on a scan done for another reason.
- Small tumors without symptoms are often watched with periodic MRI.
- Surgery, radiation, or both are considered for growing tumors or tumors causing symptoms.
- Follow-up imaging continues for years, because meningiomas can return.
What a meningioma is
Meningiomas are the most common tumor that starts inside the skull. They are more common in women and in older adults, and in people with prior radiation to the head or the genetic condition neurofibromatosis type 2. Most are WHO grade 1, meaning slow-growing and noncancerous. A smaller number are grade 2 (atypical) or grade 3, which grow faster and are more likely to return. The National Cancer Institute explains grades and risk factors.
Symptoms depend on location. A meningioma may cause headaches, seizures, weakness, changes in vision, hearing, smell, or personality, or no symptoms at all. Tumors at the skull base can sit near the nerves for vision, eye movement, and facial sensation.
Watching with MRI
For a small meningioma that causes no symptoms, careful observation is often a sound choice. A typical plan is a repeat MRI a few months after diagnosis, then at longer intervals if the tumor is stable. Many such tumors grow very slowly or not at all.
Observation is an active plan. Report new symptoms promptly, keep imaging appointments, and ask what change in size or symptoms would lead to treatment. Mayo Clinic describes when observation is used.
Surgery
Surgery is often recommended for meningiomas that are growing, causing symptoms, or pressing on the brain or nerves. The goal is usually to remove as much of the tumor as is safe, along with its attachment to the covering of the brain when possible. Removal also provides tissue to confirm the grade, which guides follow-up.
Most meningiomas are removed through a craniotomy. Some at the front of the skull base can be reached through the nose with an endoscope. When a tumor is wrapped around important nerves or blood vessels, leaving a small part behind and treating it with radiation can protect function. The AANS describes surgical options.
Radiation and radiosurgery
Radiation can stop or slow the growth of many meningiomas. Stereotactic radiosurgery delivers a focused dose in one or a few sessions and is often used for small tumors or remaining tumor after surgery, particularly at the skull base. Conventional radiation therapy over several weeks may be used for larger or higher-grade tumors.
Radiation does not remove the tumor; the usual aim is control, meaning the tumor stops growing. Side effects depend on the dose and nearby structures and can include temporary swelling. Your neurosurgeon and radiation oncologist can explain the options for your situation. The National Cancer Institute summarizes treatment approaches.
Material risks of treatment
Surgical risks include bleeding, infection, stroke, seizures, spinal fluid leak, and new or worsened neurological problems such as weakness, speech, vision, or hearing changes. Tumors at the skull base or near large veins carry specific risks that depend on location.
Seizure medicines, steroids for swelling, and hormone checks may be part of care. Ask how your tumor's location affects the risks of surgery, radiation, and observation.
Recovery and long-term follow-up
Recovery after craniotomy usually involves a hospital stay of a few days and a gradual return to activity over weeks. The craniotomy recovery guide covers incision care, medicines, and warning signs.
Meningiomas can recur even after complete removal, so periodic MRI scans continue for years. The schedule depends on the grade and how much tumor was removed. Call 911 for a seizure lasting more than five minutes, sudden severe headache, new confusion, weakness, or trouble speaking. The NHS describes follow-up for noncancerous brain tumors.
Questions for your care team
- Is my tumor likely a meningioma, and what is its size and location?
- Is observation reasonable for me, and what would change the plan?
- If surgery is advised, how much of the tumor can be removed safely?
- Would radiation or radiosurgery play a role, now or later?
- How often will I need MRI scans after treatment?
Sources and further reading
These sources support the general information on this page. Instructions from other institutions may differ from your own care plan.