The brain and spinal column make up the central nervous system (CNS), where all vital functions of the body are controlled. When a tumor arises in the CNS, it can be especially problematic because a person's thought processes and movements can be affected. This type of tumor can also be difficult to treat because the tissues surrounding the tumor may be vital to functioning.

This guide focuses on meningioma, a type of tumor that occurs in the meninges, which are the membranes that surround and protect the brain and spinal cord. There are three meningeal layers called the dura mater, arachnoid, and pia mater. A meningioma is a slow growing tumor that usually forms on the surface of the brain and may cause significant symptoms if it grows and presses on the brain or spinal cord. Approximately 85% of meningiomas are benign (noncancerous). The remaining 15% are atypical (a type of slow growing tumor that has the potential to turn cancerous or spread) or, in 1 to 2% of cases, malignant (cancerous).

Subtypes

Meningioma is classified into subtypes based on the location of the tumor.

Falx and parasagittal meningioma (accounts for 25% of meningioma cases). The falx is a membrane sitting in a groove that runs between the two sides of the brain. It contains a large blood vessel. Parasagittal meningioma occurs near the falx.

Convexity meningioma (20%). This type of meningioma occurs on the upper surface of the brain.

Sphenoid meningioma (20%). The sphenoidal ridge is located behind the eyes. Sphenoid meningioma occurs mostly in women.

Olfactory groove meningioma (10%). This type of meningioma occurs along the nerves that connect the brain to the nose.

Posterior fossa meningioma (10%). Posterior fossa meningioma develops at the back of the brain, on its underside.

Suprasellar meningioma (10%). Suprasellar meningioma occurs next to the sella turcica, a bony box on the top of the head in which the pituitary gland sits.

Spinal meningioma (less than 10%). Most common in women between the ages of 40 and 70, a spinal meningioma will usually occur in the spine at chest level and may push against the spinal cord. Spinal meningioma may cause symptoms, such as pain radiating around the chest wall, bladder trouble, and/or weakness or numbness in the legs.

Intraorbital meningioma (less than 10%). This type of meningioma develops in or around the eye sockets.

Intraventricular meningioma (2%). Intraventricular meningioma occurs in the chambers that carry fluid throughout the brain.

Statistics

Meningioma accounts for approximately13% to 30% of primary brain tumors (tumors that originate in the brain) and occurs in approximately six of every 100,000 people. Meningioma is rare in children.

The two-year relative survival rate (the percentage of patients who survive at least two years after the meningioma is detected, excluding those who die from other diseases) for meningioma that can be surgically removed is 82%. The five-year and 10-year relative survival rates are 72% and 60% for meningioma that can be surgically removed, respectively.

Statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of tumor in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with meningioma. Because the survival statistics are measured in five-year (or sometimes one-year) intervals, they may not represent advances made in the treatment or diagnosis of this tumor.

Sources: National Cancer Institute, Central Brain Tumor Registry of the United States, and Castillo, German C., MD, FCIS “Meningioma, Brain” eMedicine 6 August 2004 <http://www.emedicine.com/RADIO/topic439.htm>.

A risk factor is anything that increases a person's chance of developing a disease, including cancer. There are risk factors that can be controlled, such as smoking, and risk factors that cannot be controlled, such as age and family history. Although risk factors can influence disease, for many risk factors it is not known whether they actually cause the disease directly. Some people with several risk factors never develop the disease, while others with no known risk factors do. Knowing your risk factors and communicating with your doctor can help guide you in making wise lifestyle and health-care choices.

The risk factors for meningioma include:

Age. Adults between 30 and 70 are most likely to be diagnosed with meningioma. Children rarely develop meningioma.

Gender. Women are more than twice as likely as men to develop meningioma; however, men are three times as likely as women to be diagnosed with malignant meningioma.

Radiation exposure. High-dose radiation to the head may increase a person's risk of developing meningioma. Also, low-dose radiation in the treatment of tinea capitis (ringworm of the scalp) may increase a person's risk of developing meningioma decades after treatment.

Genetic disorders. People with neurofibromatosis type 2 (NF2) are at higher risk for developing meningioma. People with NF2 are also more likely to develop malignant or multiple meningioma.

Ethnicity. In the United States, black people have higher rates of meningioma than white people. Meningioma is more prevalent in Africa than in North America or Europe.

At this time, there is no known means of preventing meningioma.

A person with meningioma often experiences the following symptoms. Sometimes, a person with meningioma does not show any of these symptoms. Or, these symptoms may be similar to symptoms of other medical conditions. If you are concerned about a symptom on this list, please talk to your doctor.

Symptoms of meningioma can be general (due to the pressure of the tumor on the brain or spinal cord), or specific (due to the interruption of the normal functioning of a specific part of the brain or pressure on nerves or blood vessels). Generally, meningioma is not diagnosed until symptoms begin.

General symptoms include:

• Headaches, which may be severe and may worsen with activity or in the early morning



• Seizures



• Mental changes (such as personality or memory changes)



• Nausea or vomiting



• Vision changes, such as blurred vision

Symptoms that may be specific to the location of the tumor include:

Falx and parasagittal meningioma

• Leg weakness

Convexity meningioma

• Seizures



• Headaches



• Focal neurological deficits (These problems with nerve function affect either a specific location, such as the left side of the face, right side of the face, left arm, right arm, left leg, right leg, or a small area, such as the tongue. The tumor can also affect a specific function. For example, speech may be affected, but not the ability to write. It also may result in a loss of movement or sensation.)



• Mental changes

Sphenoid meningioma

• Facial symptoms (loss of sensation or numbness in the face)



• Vision problems (loss of patches within field of vision, blindness, double vision)

Olfactory groove meningioma

• Loss of sense of smell



• Vision problems

Posterior fossa meningioma

• Facial symptoms (sharp pain in the face, facial numbness, spasms of the facial muscles)



• Loss of hearing



• Difficulty swallowing



• Trouble walking

Suprasellar meningioma

• Swelling of the optic disk (the region in the retina where nerve fibers come together to form part of the optic nerve)



• Vision problems

Spinal meningioma

• Back pain



• Pain in the limbs or chest

Intraorbital meningioma

• Bulging of the eye



• Loss of vision

Intraventricular meningioma

• Mental changes



• Headaches



• Dizziness

Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:

• Age and medical condition
• The type of cancer
• Severity of symptoms
• Previous test results

Meningioma is often not diagnosed until symptoms appear. The neuro-oncologist (a doctor who specializes in diagnosing and treating brain tumors and other tumors of the nervous system) can use the patient's symptoms as clues to the location of the tumor. In addition to obtaining the patient's detailed medical history and doing a physical examination, an oncologist or neuro-oncologist may order some of the following tests to determine the presence, and perhaps the subtype or grade (how closely the cancer cells resemble normal tissue under a microscope), of meningioma:

Imaging tests

Radiologic tests are most useful when they are combined with the patient's history, physical examination, and neurological tests. This combination of results helps to more accurately determine where the cancer began, and whether or where it has spread. The most common imaging tests used for diagnosing meningioma include:

X-ray. An x-ray is a picture of the inside of the body. An x-ray of the head can sometimes help doctors determine the presence and location of meningioma, but is not sufficient to diagnose the type of tumor.

Computed tomography (CT or CAT) scan. A CT scan takes x-rays of the head from many different angles. A computer then puts these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan is best for detecting changes in the skull bone sometimes caused by meningioma.

Magnetic resonance imaging (MRI). An MRI uses electromagnetic waves to create computer-generated pictures of the brain. MRIs may create more detailed pictures than CT scans and are the preferred method of diagnosing meningioma.

Cerebral angiogram. A cerebral angiogram is an x-ray, or series of x-rays, of the head that shows the arteries and veins in the brain. X-rays are taken after a contrast medium (a special dye) is injected into the main arteries of the head. Because a meningioma can block important veins that drain blood from the brain, it is sometimes important to get an angiogram to allow proper planning before an operation is performed.

Positron emission tomography (PET) scan. In a PET scan, radioactive sugar molecules are injected into the body. Tumor cells absorb sugar more quickly than normal cells, so they light up on the PET scan. PET scans are often used to complement information gathered from CT scan, MRI, and physical examination.

Neurological, vision, and hearing tests. These tests help determine the suspected tumor's effects on the brain's functioning. An eye examination can detect changes to the optic nerve caused by a meningioma that is putting pressure on it.

Lumbar puncture (spinal tap). A lumbar puncture is a procedure in which a doctor takes a sample of cerebrospinal fluid (CSF) to look for cancer cells, blood, or tumor markers (substances found in higher than normal amounts in the blood, urine, or body tissues of people with certain types of cancer). CSF is the fluid that flows around the brain and the spinal cord. Doctors generally give an anesthetic to numb the lower back before the procedure. Lumbar puncture is rarely needed in patients with meningioma.

Electroencephalography (EEG). An EEG is a noninvasive test in which electrodes are attached to a person's scalp to measure electrical activity of the brain. Specifically, EEGs are used to detect seizure activity. Because meningiomas can cause seizures in some patients, EEGs are occasionally needed for patients with this tumor.

Stereotactic neurosurgery or biopsy. In this procedure, doctors use computer guidance to insert a needle into a precise location and retrieve a tissue sample of the tumor. A biopsy is the only definitive way a meningioma diagnosis can be made. A biopsy can be performed by needle placement (meaning by stereotactic technique), or it can be done at the time of surgery when the tumor is exposed and available for direct inspection by the surgeon. Most meningiomas are removed rather than simply biopsied, and as a result, most surgery done for meningioma is not done as a stereotactic procedure, but rather by an open craniotomy (surgery where part of the skull is removed to provide access to the brain).

After meningioma has been diagnosed, additional tests will be done to learn more about the tumor. There is no formal staging system for meningioma, because CNS tumors cannot be staged the same way as other cancers.

Doctors use six factors to establish the course of treatment and to determine prognosis (chance of recovery):

Tumor histology. How a tumor looks under a microscope is called tumor histology. A sample of the tumor is removed during surgery for biopsy. When surgery is not possible, a biopsy alone is done.

Using the histology, the doctor can determine the type of tumor and its grade. Grading describes how closely the cancer cells resemble normal tissue under a microscope. To decide on a treatment, both the type and grade of the tumor must be established.

Normal brain tissue usually has differentiated tissue (different types of cells grouped together). Brain tissue that is cancerous is usually made up of cells that look more alike. In general, the less differentiated the brain tissue and the higher the grade, the worse the prognosis.

To determine the histology of a tumor, doctors also look at:

• Mitosis (the number of cells dividing)



• Hypercellularity (the tumor contains large numbers of cells)



• Vascular proliferation (blood vessels in the tumor are growing)



• Necrosis (dead tissue in the tumor)

In general, a meningioma is classified into one of three grades:

• A grade I tumor does not have mitosis or necrosis.



• A grade II tumor is hypercellular and has mitosis and may have a limited degree of necrosis, but does not invade the adjacent brain. This is usually called "atypical."



• A grade III tumor has necrosis and often shows brain invasion. This is usually called "anaplastic."

Age of patient. In adults, the age of the patient at the time of diagnosis is one of the most powerful predictors of prognosis. In general, the younger the adult, the better the prognosis.

Extent of tumor residual. Resection refers to surgery to remove a tumor, and residual refers to how much of the tumor was left behind after surgery. Three classifications are used:

• Gross total. The entire tumor was removed (microscopic cells may remain).



• Subtotal. Only part of the tumor was removed.



• Biopsy only. Only a small portion, used for a biopsy, was removed.

The outcome is most favorable when all of the tumor can be resected (surgically removed).

Tumor location. Tumors can form in any part of the CNS. Some tumor locations cause greater damage than others, and some tumors are harder to completely remove than others.

Functional neurologic status. The doctor will test how well a patient's CNS is working by using an assessment called the Karnofsky Performance Scale. A higher score indicates a better prognosis.

Metastatic spread. Meningioma rarely metastasizes to other parts of the body. One reason for this is that a meningioma is more self-contained than a tumor that forms elsewhere in the body. Another reason metastasis does not occur often with brain tumors is due to the fact that the brain does not have a well-formed lymph system to carry cancer cells elsewhere in the body. Cerebrospinal fluid can spread cancer cells, but this is rare with meningioma.

Biogenetic markers

At present, the factors listed above are the best indicators of the prognosis (chance of recovery) for a person with meningioma. Researchers are currently looking for tumor markers (proteins or other substances found in the blood that can indicate the presence of cancer) in the tumor tissue that could make meningioma easier to diagnose and staging of adult brain cancer possible in the future. These tools may someday make it possible for doctors to analyze the growth potential of brain tumors, develop more effective treatments, and more accurately predict prognosis.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.

Patients diagnosed with a CNS tumor generally need to seek treatment as soon as possible. The pressure caused by a growing CNS tumor can cause severe symptoms, including a backup of cerebrospinal fluid and problems with blood circulation, which can damage delicate nerves and deprive cells of nourishment.

Treating brain and spinal cord tumors can be difficult. The blood-brain barrier, which normally serves to protect the brain and spinal cord from damaging chemicals entering those structures, also keeps out many types of chemotherapeutic drugs. Meningioma grows outside the blood-brain barrier, so drugs do reach these tumors; nonetheless, they are quite resistant to cure by currently available chemotherapeutic drugs. Surgery can be difficult if the tumor is near a delicate portion of the brain or spinal cord. Radiation therapy can damage healthy tissue. However, research in the past two decades has improved the survival rates of patients with CNS tumors. More refined surgeries, a better understanding of what types of tumors respond to chemotherapy, and precise delivery of radiation therapy have resulted in a longer life span and better quality of life for patients with CNS tumors, including meningiomas.

Surgery

Surgery is the most common type of treatment for meningioma and is often the only treatment performed. There have been rapid advances in surgery for brain tumors, including the use of cortical mapping (a technique that records the functions of a specific part of the brain by placing electrodes directly on the surface of the brain) and enhanced imaging devices to give surgeons both anatomical and functional information, which helps them plan and perform the surgery and make it safer.

Surgery to the brain requires the removal of part of the skull, a procedure called a craniotomy. After the surgeon removes the tumor, the patient's own bone will be used to cover the opening in the skull.

In addition to removing or reducing the meningioma, surgery can provide a biopsy (tissue samples for analysis). The results of the analysis can show if additional treatments, such as radiation therapy, will be useful.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. Oncologists may use radiation therapy along with surgery to slow the growth of aggressive tumors. Radiation can be directed in multiple ways. External-beam radiation therapy techniques use a machine outside the body to target the tumor. These techniques are becoming increasingly more precise. External-beam radiation may be used for meningioma.

Internal radiation therapy, or brachytherapy, involves tiny pellets or rods containing radioactive materials that are surgically implanted in or near the tumor site and generally is not used except in experimental settings.

The following radiation therapy techniques may be used:

Conventional radiation therapy. The treatment area is set up based on anatomic landmarks and x-rays. In certain situations, such as whole brain radiation therapy for brain tumors, this technique is appropriate. For more precise targeting, more elaborate techniques are required. Chemotherapy may be used in combination with radiation therapy.

Three-dimensional conformal radiation therapy. Based on CT scans and MRI scans, a three-dimensional model of the tumor and normal tissues is created on a computer. Beam size and angles are determined in a way that maximizes the dose of radiation to the tumor, while minimizing the amount of radiation exposure to normal tissue.

Stereotactic radiosurgery. In stereotactic radiosurgery, a computer assembles images from CT scans, MRI scans, or both to locate the tumor and help direct the radiation. It involves delivering a single, high dose of radiation directly to the tumor and not healthy tissues. It works best for a tumor that is only in one area of the brain and for benign tumors (including meningioma). There are three methods by which stereotactic radiosurgery is performed:

• A modified linear accelerator is a machine that creates high-energy radiation by using electricity to form a stream of fast-moving subatomic particles, which can then be focused onto a tumor target.
• 
  
  
• A gamma knife is another form of radiation therapy that concentrates highly focused beams of radioactivity on the tumor. A gamma knife can only be used for meningioma in the brain, not meningioma on the spine.
• 
  
  
• A cyber knife is a device used in radiation therapy to guide radiation to the tumor target-particularly targets in the brain, head, and neck regions.

Fractionated stereotactic radiation therapy. Radiation therapy is delivered with stereotactic precision, but divided into small, daily fractions over several weeks using a relocatable head frame, in contrast to the one-day radiosurgery. This technique is ideal for tumors located close to complex or sensitive structures, such as the optic nerves or brain stem.

Intensity modulated radiation therapy (IMRT). Radiation therapy is delivered with greater intensity or dose to thicker areas of the tumor and with less intensity to thinner areas of the tumor. This is accomplished by placing tiny metal leaves in the path of the beam to reduce the intensity of the beam and to customize the shape of the dose to the shape of the tumor.

All of these more elaborate techniques are designed to achieve greater precision and minimize the dose to the surrounding normal tissue. Depending on the size and location of the tumor, the radiation oncologist may choose any of the above radiation therapy techniques. In certain situations, a combination of two or more techniques is appropriate.

Children younger than five are not usually appropriate candidates for radiation therapy because of potential danger to their developing brains.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor's growth, or reduce symptoms. Chemotherapy is very rarely used in the treatment of meningioma, although current research is investigating this form of treatment.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases.

Recurrent meningioma

If, in spite of initial treatment, the meningioma does not go into remission (the temporary or permanent disappearance of a tumor) or if it recurs (comes back after treatment), a patient can still receive care to manage the symptoms caused by the tumor. Symptom management is always important since the symptoms of meningioma can interfere with quality of life.

The most common treatment for recurrent meningioma is additional surgery. If surgery cannot be performed, radiation therapy is generally used.

Doctors and scientists are always looking for better ways to treat patients with meningioma. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments, such as new chemotherapy before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding new drugs and other therapies is the only way to make progress in treating meningioma. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with meningioma.

To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient's options, so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.

Cancer and treatment can cause a variety of side effects; some are easily controlled and others require specialized care. Below are some of the side effects that are more common to meningioma and its treatments. For more detailed information on managing these and other side effects of cancer and cancer treatment, visit the Cancer.Net Managing Side Effects section.

Anemia. Anemia is common in people with cancer, especially those receiving chemotherapy. Anemia is an abnormally low level of red blood cells (RBCs). RBCs contain hemoglobin (an iron protein) that carries oxygen to all parts of the body. If the level of RBCs is too low, parts of the body do not get enough oxygen and cannot work properly. Most people with anemia feel tired or weak. The fatigue (tiredness) associated with anemia can seriously affect quality of life and make it more difficult for patients to cope with cancer and treatment side effects.

Appetite loss. Appetite changes are common with cancer and cancer treatment, including chemotherapy. Individuals with a poor appetite or appetite loss may eat less than usual, not feel hungry at all, or feel satiated (full) after eating only a small amount. Ongoing appetite loss can lead to weight loss, malnutrition, and loss of muscle mass and strength. The combination of weight loss and loss of muscle mass, also called wasting, is referred to as cachexia.

Fatigue. Fatigue is extreme exhaustion or tiredness, and is the most common problem that people with cancer experience. More than half of patients experience fatigue during chemotherapy or radiation therapy, and up to 70% of patients with advanced cancer experience fatigue. Patients who feel fatigue often say that even a small effort, such as walking across a room, can seem like too much. Fatigue can seriously impact family and other daily activities, can make patients avoid or skip cancer treatments, and may even impact the will to live.

Hair loss (alopecia). A potential side effect of radiation therapy and chemotherapy is hair loss. Radiation therapy and chemotherapy cause hair loss by damaging the hair follicles responsible for hair growth. Hair loss may occur throughout the body, including the head, face, arms, legs, underarms, and pubic area. The hair may fall out entirely, gradually, or in sections. In some cases, the hair will simply thin-sometimes unnoticeably-and may become duller and dryer. Losing one's hair can be a psychologically and emotionally challenging experience and can affect a patient's self-image and quality of life. However, the hair loss is usually temporary, and the hair often grows back.

Mental confusion (delirium). Delirium is a common problem for patients with cancer, especially those with advanced cancer or those at the end of life. It is present in 15% to 30% of patients who are hospitalized for cancer and in up to 85% of those in the last weeks of life. Delirium can be very stressful on the patient and his or her family members. It can also interfere with other symptoms and treatments for the cancer, including pain. The direct cause of delirium is usually a brain tumor or cancer that started somewhere else and has spread to the brain. Other causes of delirium include medicine, withdrawal from medicine, electrolyte imbalance, organ failure, infection, other brain disorders, and lack of oxygen in the blood. The symptoms of delirium include depression; delusions or hallucinations; restlessness; anxiety; sleep disturbance; irritability; altered level of consciousness or awareness; shortened attention span; memory problems; disorganized thinking and speech; disorientation; reversing day and night; difficulty writing, drawing, or finding words; and personality changes.

Nausea and vomiting. Vomiting, also called emesis or throwing up, is the act of expelling the contents of the stomach through the mouth. It is a natural way for the body to rid itself of harmful substances. Nausea is the urge to vomit. Nausea and vomiting are common in patients receiving chemotherapy for cancer and in some patients receiving radiation therapy. Many patients with cancer say they fear nausea and vomiting more than any other side effects of treatment. When it is minor and treated quickly, nausea and vomiting can be quite uncomfortable but cause no serious problems. Persistent vomiting can cause dehydration, electrolyte imbalance, weight loss, depression, and avoidance of chemotherapy.

Nervous system disturbances. Nervous system disturbances can be caused by many different factors, including cancer, cancer treatments, medications, or other disorders. Symptoms that result from a disruption or damage to the nerves caused by cancer treatment (such as surgery, radiation treatment, or chemotherapy) can appear soon after treatment or many years later. See Managing Side Effects: Nervous System Disturbances for the most common symptoms.

Because it is possible that tumors may recur, people treated for meningioma are routinely monitored for new symptoms with regularly repeated MRI scans. The frequency of the checkups and scans varies greatly from patient to patient and will be determined by the oncologist or neuro-oncologist. People treated for benign meningioma typically have annual follow-up visits, including an MRI scan and consultation with a neurosurgeon or neuro-oncologist. More aggressive tumors may require more frequent checkups and ongoing intervention after recovery from surgery.

As described in previous sections, meningioma and its treatments can affect the functioning of the brain as well as the well-being of the patient. For this reason, it is sometimes helpful to assess the patient's cognitive abilities through specialized tests, often given by a neuropsychologist (a psychologist who studies neurobiologic causes of brain disorders and specializes in diagnosing and treating these disorders using a predominantly medical [as opposed to psychoanalytical] approach), and also to assess the quality of life of the patient. These assessments could identify certain problems that may benefit from specific therapies, such as speech or occupational therapy, counseling with a social worker, or prescription medications that can help to reduce fatigue or enhance memory. Whenever possible, patients are also highly encouraged to participate in support groups.

In addition, people with impairments in function, such as weakness or imbalance, may benefit by consulting a doctor who specializes in rehabilitation medicine, because the specialist may be able to recommend strategies for recovery.

Research involving more advanced diagnostic procedures and treatments for meningioma continues. The following advancements may still be under investigation in clinical trials and may not be approved or available at this current time. Always discuss all diagnostic and treatment options with your doctor. The following meningioma developments are being explored:

Hyperfractionization uses smaller doses of radiation therapy at more frequent intervals.

Gene therapy seeks to correct faulty genes that are causing tumor growth.

Hormonal drugs are being investigated because research has shown a possible link between meningioma and hormone levels.

Immunotherapy boosts the body's immune system to attack the tumor.

Antiangiogenesis therapy is the use of drugs to stop tumors from developing new blood vessels. Without blood vessels feeding the tumor with blood, the tumor cannot grow.

Drugs affecting other intracellular functions are also being tested, including drugs that affect molecules that control cell division through signal transduction pathways.

Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:

• How many patients with this type of tumor do you treat each year?



• Does your practice include multidisciplinary care?



• Do you attend expert meetings to discuss complicated tumor cases? What kinds of specialists attend such meetings?



• Will an experienced neuropathologist (a doctor who specializes in the diagnosis of diseases of the nervous system by studying tissue under a microscope) review my pathology slides?



• Should I get a second opinion?



• Are there CNS tumor centers of excellence that you recommend?



• Do you work with a social worker that assists patients with CNS tumors?



• Do you know of a local support group for patients with CNS tumors?



• Do you have reading material that would help me understand my disease?



• Are you willing to follow my case if I have my treatments provided in another center?



• Are there clinical trials open for this type of tumor?



• Who answers patient questions when you are unavailable?