Meningioma, a primary central nervous system (CNS) tumor, begins in the brain or spinal cord. About 35% of all primary brain tumors are meningiomas. However, higher-grade meningiomas are very rare. With a yearly incidence of approximately 7.44/100,000, they are more common in women, with a 2:1 female-to-male ratio of cases.
The cost of meningioma treatment in India ranges from USD 5000 to USD 7200.
What is Meningioma?
The meninges are protective linings around the brain and spinal cord viz dura mater, arachnoid mater, and pia mater. Meningioma arises from these layers. The most common symptom is no symptoms; as it grows, it compresses the neurovascular structures and complicates surgery.
Most meningiomas are usually noncancerous or benign; very rarely, a meningioma may be cancerous or malignant. Some meningiomas are termed atypical, meaning they are neither benign nor malignant but instead something in between.
What are the Symptoms of Meningioma?
The slow-growing characteristics of meningiomas often only make them noticeable once significant. Sometimes, meningiomas may remain asymptomatic for a patient’s lifetime or are detected unexpectedly during a brain scan for unrelated symptoms.
Symptoms of meningiomas may include:
- Headaches
- Progressive focal neurologic deficit
- Confusion
- Nausea or vomiting
- Seizures
- Change in personality or behavior
- Hearing loss or ringing in the ears
- Visual disorders
- Muscle weakness
- Drowsiness
Symptoms can also be explicitly related to the location of the meningioma, such as:
- Falx and parasagittal: Impaired brain functioning levels, such as reasoning and memory. It could cause leg weakness/numbness or seizures if located in the middle section.
- Convexity: This may cause seizures, headaches, and neurological deficits.
- Olfactory groove: Results in loss of smell due to nerve compression between the brain and the nose. Vision problems may occur due to optic nerve compression if the tumor grows large enough.
- Sphenoid: This may result in vision problems, seizures, or facial numbness.
- Suprasellar: This may cause vision problems due to the optic nerves/chiasm compression.
- Posterior fossa: This may cause unsteady gait, problems with coordination, facial symptoms, or loss of hearing due to compression of cranial nerves.
- Intraorbital: This may cause pressure buildup in the eyes, leading to potential vision loss.
- Intraventricular: This may block the flow of cerebrospinal fluid, resulting in obstructive hydrocephalus, which may lead to lightheadedness, headaches, and changes in mental function.
- Spinal: This may result in back pain or limb pain caused by nerve compression that runs into the spinal cord.
Dr. Radheshyam Naik is a renowned Medical Oncologist with expertise in managing cancers. He has a particular interest in hematological disorders and bone marrow transplantation (BMT). His areas of expertise also include stem cell therapy, hemato-oncology, allogeneic and haploidentical bone marrow transplant, along with the treatment of kidney, prostate, lung, bones, colorectal, and genitourinary cancers.
What are the Risk Factors of Meningioma?
Some common risk factors of meningioma include the following:
- The risk of meningioma increases with age, with a surprising increase after 65 years.
- Exposure to high doses of ionizing radiation is also associated with a higher number of meningioma cases. Many studies have linked the number of full-mouth dental radiographs to an increased risk of meningioma.
- Neurofibromatosis type 2 (NF2) is a genetic disorder associated with a higher risk of developing meningioma. Patients with NF2 are also more likely to develop malignant or multiple meningiomas.
- According to the Brain Science Foundation, a correlation exists between meningiomas and hormones such as:
- Increased occurrence of meningioma in post-pubertal women
- Detection of progesterone, estrogen, and androgen receptors in a significant number of meningiomas
- A higher female-to-male incidence ratio during reproductive years that disappears with increasing age
- A link between meningioma growth, menstrual cycles, and pregnancy
What are the Grades of Meningiomas?
Meningiomas are graded based on the tumor’s location, type, the extent of spread, genetic findings, the patient’s age, and the tumor remaining after surgery. Meningiomas are grouped into three grades based on their characteristics. Each grade includes different meningioma subtypes.
- Grade I meningiomas: Low-grade tumors are the most common and grow slowly.
- Grade II atypical meningiomas: Mid-grade tumors have a higher chance of returning after removal. The subtypes comprise choroid and clear-cell meningioma.
- Grade III anaplastic meningiomas: Malignant (cancerous), fast-growing tumors. The subtypes comprise papillary and rhabdoid meningioma.
Dr. Naik is also known for performing the first intra-arterial chemotherapy using a port and is also credited for performing the first BMT in Karnataka. Dr. Naik has pioneered conducting various drug trials and studied over 50 chemotherapy drugs in national and international clinical trials.
What are the Types of Meningioma?
The different types of meningioma include the following:
- Convexity meningioma grows on the brain’s surface directly under the skull, accounting for approximately 20% of meningiomas. They may only present symptoms once the tumor becomes large enough to push on the brain.
- Intraventricular meningioma forms in the brain where cerebrospinal fluid (CSF) is made and distributed. It may cause a blockage of CSF flow, leading to hydrocephalus.
- Falcine and parasagittal meningioma form in or next to the falx (a thin layer of tissue between the two sides of the brain).
- Skull base meningioma grows in the bones, forming the bony ridge behind the eyes and the bottom of the skull.
- Sphenoid wing meningioma constitutes approximately 20% of meningiomas and forms on the skull base behind the eyes.
- Olfactory groove meningiomas account for around 10% of meningiomas and form along the nerves between the brain and nose. It can cause a loss of smell and vision issues.
- Posterior fossa / petrous meningioma forms on the brain’s underside, accounting for around 10% of meningiomas.
- Suprasellar meningioma arises from the skull base near the pituitary gland and the optic nerve. It can cause visual problems and pituitary gland dysfunction.
- Recurrent meningioma, when it occurs, maybe the same grade or a more aggressive or malignant form.
What are the Treatment Options for Meningioma?
The treatment for meningioma includes the following:
- Surgery: Surgery is a treatment option for meningioma, a type of brain tumor. During surgery, the tumor and the fibers that connect it to the brain coverings are removed. However, there are certain risks associated with complete removal, especially when the tumor has spread to surrounding brain tissue or veins. Post-surgery, the patient is closely monitored with regular check-ups and MRIs. To ensure safety during the surgery, it is common for the patient to undergo preoperative embolization of the tumor.
- Radiation therapy: High-energy X-rays kill abnormal brain cells, cancer cells, and shrink tumors. It may be an option if the tumor cannot be treated effectively through surgery. Besides 3-D conformal radiotherapy (3DCRT), new delivery techniques include intensity-modulated radiotherapy (IMRT). The advantage of this therapy is that less damage is done to the tissue surrounding the tumor. Stereotactic radiosurgery (such as Novalis, Gamma Knife, and Cyberknife) focuses the radiation with many different beams on the target tissue. It also incurs less damage to tissues adjacent to the tumor.
- Chemotherapy: Chemotherapy is used only in atypical or malignant subtypes that cannot be treated with surgery or radiation therapy.
How Does the Cost Differ Based on the Type of Meningioma?
The cost of meningioma treatment in India depends on tumor size, location, and the surgeon’s expertise. Common surgical approaches include:
- Craniotomy: Craniotomy surgery can cost anywhere from USD 10,000 to USD 1,00,000 or more.
- Minimally invasive techniques: The average cost of minimally invasive approaches, such as endoscopic or stereotactic techniques, ranges from USD 12,000 to USD 13,000.
Meningioma, the most common primary neoplasm of the CNS, is generally benign and has a good prognosis. Dealing with aggressive variants and poor prognosis can make the treatment process quite challenging. The affordable cost of meningioma treatment in India is an added advantage for patients traveling from other countries.