Meningioma is a relatively serious brain disease that originates from the meninges and derivatives of the meningeal space, accounting for 19.2% of intracranial tumors and ranking 2nd in the occurrence of intracranial tumors. It is the most common type of benign intracranial tumor. If not detected in time, it may have a great impact on patients’ health and may delay treatment. Therefore, it is very important to understand the symptoms of meningioma.
Common types and manifestations of meningioma
1. Parasagittal sinus and pars falciparum meningiomas: they account for about half of the total number of meningiomas, grow slowly, and are usually very large when patients develop symptoms.
2.Meningioma of the convex surface of the brain: accounting for 25%, from psychiatric symptoms to motor disorders, sensory disorders, visual field defects can appear, the incidence of epilepsy is high and often the first symptom, may be accompanied by the performance of intracranial hypertension.
3, olfactory sulcus meningioma and anterior skull base meningioma: 8%-18%, early symptoms are olfactory hyposmia until loss, vision loss when intracranial pressure increases, tumor can affect frontal lobe function causing excitement, hallucinations, delusions, retardation, mental apathy, few patients have epilepsy.
4.Saddle node and saddle diaphragm meningioma: accounting for 4-10%, often with visual impairment as the first symptom; headache, a few patients may appear drowsiness, memory loss, anxiety and other mental symptoms; some tumors affect the pituitary function may appear endocrine dysfunction, such as hypoactive sexual desire, impotence, amenorrhea, etc.; some patients visit the clinic because of loss of smell, epilepsy, motoneural palsy as the first symptom.
5.Pterygoid crest meningioma: accounting for 12%, the tumor originates from the anterior bed protrusion, which may manifest as vision loss or even blindness; when invading into the orbit or supraorbital area, eye protrusion, eye movement disorder, pupil dilatation; epilepsy, psychiatric symptoms, olfactory disorder, etc.
6.Mid-cranial fossa and paracranial meningioma: accounting for 6%, trigeminal neuralgia, eye movement disorder, eyelid ptosis, diplopia, vision loss, isotropic hemianopia, etc. may occur.
7.Lateral ventricular meningioma: accounting for 4-5%, because of intracerebroventricular growth, early neurological impairment is not obvious, but by the time of consultation, the tumor is already large and intracranial pressure is already high, often manifesting as headache, optic papilledema, epilepsy, isotropic hemianopia and contralateral limb hemiparesis.
8. Meningioma of the posterior fossa: accounting for 14%, including: meningioma of the cerebellar convexity, meningioma of the cerebellar curtain, meningioma of the pontocerebellar horn, meningioma of the slope, meningioma of the greater occipital foramen, meningioma of the fourth ventricle.
(1) Meningioma of the cerebellar convexity: the main clinical manifestations are symptoms of increased intracranial pressure and cerebellar signs, mostly starting with headache with vomiting and optic disc edema.
(2) Meningioma of the cerebellar curtain: coarse horizontal tremor and ataxia on the affected side, visual field disorders, etc.
(3) Meningioma of the pontocerebellar horn: this part of the tumor is most commonly known as auditory neuroma, with clinical manifestations of hearing loss, tinnitus, facial numbness, hypesthesia, etc.
(4) Meningioma of the slope: often manifests as headache, but often goes unnoticed.
(5) meningioma of the foramen magnum: early manifestations include neck pain, numbness of the hands and upper extremities, which can be easily misdiagnosed.
(6) Meningioma of the fourth ventricle: it can cause ataxia, nystagmus and other cerebellar symptoms, and compression of the nucleus accumbens can also cause brain nerve damage and brainstem symptoms.
II. Important tests.
1.CT scan: Meningiomas are mostly substantial and rich in blood flow. CT scan shows special signs of meningioma, including limited round uniform contrast-enhanced intracranial images, bone hyperplasia, hypointense cerebral edema bands around the tumor, corresponding brain displacement, and hydrocephalus due to cerebrospinal fluid circulation obstruction.
MRI: MRI is preferred for imaging of cranial brain tumors including meningioma, and enhanced MRI should be done, because it is sensitive to soft tissue and has higher resolution than CT, which can better show the tumor and its anatomical relationship with surrounding tissues. It can perform level imaging in any direction; complete wave spectrum imaging technique in one minute; high resolution and high accuracy, which can clearly show hidden tumor lesions with high accuracy rate. In addition, fMRI, DW, MRA, DTI and other MRI techniques are very helpful for qualitative and localized diagnosis of tumors.
3.Cerebral angiography: For some meningiomas, cerebral angiography is necessary. Especially for deep meningioma, its blood supply is multi-channel, only through cerebral angiography can we understand the source of tumor supply, the degree of tumor blood flow and the distribution of adjacent blood vessels, which are of great value to the formulation of surgical plan, study of surgical access and surgical methods. Selective external carotid artery, internal carotid artery and vertebral artery angiography, especially digital subtraction angiography, can provide clearer and more definite signs of vascular changes. The intra-tumoral vascular embolization of the tumor can also be done if the situation permits, which can effectively reduce the amount of bleeding during surgery.
Treatment
Surgical resection: Surgical resection of meningioma is the most effective treatment. With the development of microsurgery technology, the use of microscopic precision surgical treatment, advanced microscope, neuronavigation, electrophysiological monitor, and microsurgery techniques make the surgical precision and accuracy better and the damage smaller, the surgical effect of meningioma is improving, and the surgical complication rate and surgical death and disability rate are significantly reduced. The preferred approach, including recurrent meningiomas, is still surgical resection. Most patients can be completely cured.
Intraoperative navigation showing the relationship between tumor and blood vessels
Radiation therapy: Due to the location of meningioma, complete resection is not possible for about 17%-50% of meningiomas and not for malignant meningiomas. In addition, malignant meningioma and vascular ependymal meningioma are sensitive to radiotherapy and the effect is sure, and they should be treated with radiotherapy after surgical resection.
Other treatments: hormone therapy, molecular biology therapy, Chinese medicine therapy, etc.
Prognosis of disease
The average postoperative survival of meningioma is 9 years, and 6 years for posterior cranial fossa and saddle node meningioma. The 10-year postoperative survival of meningioma is 43%-78%. The main causes of death after surgery are failure to completely excise the tumor, poor preoperative patient status, tumor malignancy, or concomitant cranial invasion. Factors affecting the prognosis of meningioma are also multifaceted, such as tumor size and location, tumor histologic characteristics, and extent of surgical resection. Postoperative epilepsy in patients is related to the tumor site, as well as to the surgical injury and postoperative local scarring.