Severe headache with vomiting and drowsiness, or rapidly worsening weakness, need emergency care today. Also seek urgent care for a first seizure, or sudden visual loss.
A tumour arising from the membranes covering the brain rather than from brain tissue itself. Most are benign and slow-growing, and a substantial proportion never need any treatment.
Meningioma is the brain tumour most often overtreated. Small ones found incidentally on a scan performed for something else can frequently be watched for years, and knowing that before you agree to an operation is worth a great deal.
Meningiomas arise from the arachnoid layer of the meninges — the membranes wrapping the brain — and grow inward, pushing the brain aside rather than infiltrating it. That single characteristic is what makes them so different from gliomas: there is usually a plane between tumour and brain, and complete removal is frequently achievable.
They are graded one to three. The great majority are grade one, benign and slow-growing. Grade two atypical meningiomas recur more often, and grade three anaplastic meningiomas are uncommon and behave aggressively.
They are considerably more common in women, and a proportion enlarge during pregnancy. Previous radiation to the head is a recognised risk factor, and multiple meningiomas can occur in neurofibromatosis type 2.
Because MRI is now performed frequently for headaches, dizziness and after minor head injuries, a great many meningiomas are found by accident in people with no symptoms attributable to them. Deciding what to do about those is the central question this page addresses.
Many meningiomas are discovered on scans done for headaches, dizziness or minor head injury, in people whose symptoms are not caused by the tumour at all. For a small, calcified, slow-growing tumour away from critical structures, in an older patient, the correct management is frequently a repeat scan in six to twelve months rather than an operation. Brain surgery carries real risk, and a tumour that will never cause trouble should not be the reason to accept it. If surgery has been recommended for a small incidental meningioma, ask what the growth rate is and what would happen if you waited.
MRI usually makes the diagnosis without any need for tissue.
The growth rate is often more important than the size. A meningioma unchanged over two years behaves very differently from one that has grown noticeably in six months, and that difference frequently decides between observation and surgery. Send every scan you have with its date, not only the most recent one.
Doing nothing is a legitimate and frequently correct choice.
Repeat MRI at intervals — typically six to twelve months initially, then less often if stable — with treatment only if the tumour grows or begins to cause symptoms. For small, asymptomatic, calcified tumours, particularly in older patients, this is the evidence-based approach and avoids the risks of surgery entirely.
The tumour is removed along with its dural attachment where possible. Complete removal of a grade one meningioma is frequently curative, and the extent of removal — graded on the Simpson scale — predicts the chance of recurrence. Accessibility varies enormously: a convexity meningioma is straightforward, one at the skull base wrapped around vessels and nerves is not.
Focused radiation delivered in one or a few sessions with no incision. It controls growth in the large majority of small to moderate meningiomas and is particularly useful for tumours at the skull base where surgery carries higher risk. It does not remove the tumour — it stops it growing.
For atypical or anaplastic meningiomas, and for tumours where complete removal was not possible, radiotherapy after surgery reduces the chance of recurrence. Higher-grade meningiomas need closer long-term surveillance regardless of treatment.
A tumour causing symptoms or demonstrably growing needs treatment. One doing neither often does not.
Convexity tumours are removable with low risk. Skull base tumours involving vessels and cranial nerves carry considerably more, and radiosurgery may be the better option.
An eighty-year-old with a small stable meningioma is very unlikely to be harmed by it. A forty-year-old with the same tumour has decades ahead and a different calculation.
If your scan shows a small stable meningioma and you have no symptoms attributable to it, we will tell you that observation is reasonable — even though that means no case for us.
Most meningiomas allow ample time to plan carefully. A large tumour with surrounding swelling and drowsiness is different and needs local treatment first.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
Possibly not. Many meningiomas, particularly small ones found incidentally in people without symptoms, are best watched with repeat scans. Surgery is indicated where the tumour causes symptoms, is growing, or is large enough to compress brain tissue. Ask what your growth rate is before agreeing to an operation.
The great majority are benign — grade one — and are not cancer in the usual sense. They do not spread elsewhere in the body. A minority are grade two, which recur more readily, and a small number are grade three and behave aggressively. The grade is determined on tissue after surgery, not on the scan.
Highly focused radiation delivered in one or a few sessions with no incision and usually no hospital stay. It controls growth in most small to moderate meningiomas and is especially valuable at the skull base where open surgery is riskier. It does not shrink the tumour quickly — it stops it growing, and the effect is judged over months and years.
It depends on the grade and on how completely it was removed, including its dural attachment. A completely removed grade one meningioma often does not recur. Incomplete removal, or a higher grade, carries a meaningful recurrence rate and requires continued surveillance scanning for years.
It can. Meningiomas are more common in women and some enlarge during pregnancy, occasionally causing symptoms that settle afterwards. If you have a known meningioma and are planning pregnancy, it is worth discussing beforehand so that monitoring can be arranged.
Not more dangerous in itself, but harder to remove. Skull base meningiomas can wrap around arteries and cranial nerves, and attempting complete removal may risk stroke or nerve injury. In these cases a planned partial removal followed by radiosurgery to the remnant often gives a better overall result than aggressive resection.
Send the MRI and every earlier scan you have, with dates. Growth rate over time often decides whether you need an operation at all.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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