What are benign meningiomas?
The term benign meningioma refers to benign brain tumours that affect the hard meninges. Benign meningiomas develop from the covering cells of the soft meninges and form mainly in adulthood. Women from the 5th decade of life onwards are affected by the disease with above-average frequency. The disease affects women about twice as often as men, but rarely occurs before the age of 40.
Almost 25 percent of all tumours of the central nervous system are benign meningiomas, which usually occur in isolated cases. In contrast to malignant meningiomas, benign meningiomas are sharply defined and do not grow into the adjacent brain tissue. Depending on the severity of the tumour and the type of treatment, the chances of recovery are good or poor. In any case, rehabilitation is recommended after surgical removal of the tumour.
What are the different types of benign meningiomas?
The World Health Organisation (WHO) distinguishes between the following two grades with regard to benign meningiomas:
- WHO grade I: Meningiomas account for more than 85 per cent of all benign meningiomas, which can usually be removed completely by surgery and have a favourable prognosis
- WHO grade II: Atypical meningiomas make up about 10 per cent of all benign meningiomas, which have an increased growth potential and have a high recurrence rate even after successful complete removal of the tumour. An atypical meningioma should therefore be monitored regularly after surgery.
The third WHO grade is an anaplastic meningioma, which is rather rare and describes a malignant tumour of the meninges. The classification of the tumour in this scheme is important for both treatment and prognosis.
What causes a meningioma to form?
A meningioma is caused by the degeneration of a certain type of cell. The exact reasons for this degeneration are still unclear, but doctors assume that a genetic predisposition could contribute to the development of the meningioma. Other risk factors are ionising radiation, which is why children who have been treated with radiation therapy for cancer have a greater tendency to develop meningiomas.
What symptoms can a benign meningioma cause?
Since most benign meningiomas grow rather slowly, the disease can run symptom-free for some time. Only late in the course of the disease can symptoms such as headaches or, worse, seizures occur. The symptoms can be explained by the fact that the tumour, which has become quite large, presses on other brain regions or nerve structures. In addition to the two symptoms already mentioned, the following other rather unspecific complaints can be triggered:
- Dizziness,
- Paralysis,
- Loss of the sense of smell
- Vomiting,
- Visual disturbances up to paralysis of the eye muscle,
- Respiratory and/or consciousness disorders,
- Increase in blood pressure with a simultaneous drop in heart rate,
- Pain and/or sensory disturbances,
- Gait disturbances
- Discomfort when going to the toilet
The appearance and intensity of the various symptoms depend on which region of the brain the tumour is pressing on.
How is a benign meningioma diagnosed?
If the tumour is asymptomatic, it is usually discovered by chance. This can be the case, for example, through the usual imaging procedures of a computer tomography (CT) or a magnetic resonance imaging (MRI). Furthermore, a blood flow measurement of the brain can be carried out and a tissue sample of the tumour (biopsy) can be taken. Meningiomas usually have a flat or nodular shape and are usually located in the skull. Less than ten percent of all brain tumours grow in the spinal canal or on the skin of the spinal cord.
How is a benign meningioma treated?
If the disease does not cause any symptoms, no treatment is necessary at first. The same applies to asymptomatic small meningiomas, which should only be examined at regular intervals by means of a CT scan or an MRI. However, if the benign meningioma causes symptoms, an attempt should usually be made to remove the tumour surgically. In the case of a tumour that has a severity grade of I according to the WHO, complete surgical removal is usually possible without any problems. If the tumour is very vascular, the blood vessels can be closed by means of so-called embolisation, which prevents excessive blood loss. If the meningioma cannot be removed completely by surgery, the remaining tumour cells are destroyed after the operation by means of radiation therapy.
What is the prognosis for benign meningioma?
The prognosis for a complete cure always depends on the severity of the disease. With a tumour of the first severity, the chances are good that the tumour can be completely removed, which also increases the chances of a complete cure. A type II meningioma carries the risk that even after successful surgery, the tumour will grow back after some time and another operation will be necessary. A malignant type III brain tumour is dangerous because it can metastasise and has very little chance of cure. The general 5-year survival rate with a menigeoma is about 90 percent. However, regardless of whether the chances of cure are good or bad, rehabilitation should always follow the treatment of the meningioma.
What does rehabilitation for meningioma look like?
Rehab for meningioma can be either outpatient or inpatient. Normally, patients should undergo neurological rehabilitation after surgery for benign meningioma. The focus here is on the impairments caused by the brain tumour. These may include, for example, mental deficits, impaired motor skills, disturbances in the sense of balance or speech, and even paralysis.