Meningioma

Meningioma is a benign tumor that forms from the dura mater of the brain and spinal cord. It arises from the arachnoid membrane, namely from the cells that make up the meningothelium. Meningiomas are among the most common tumors of the central nervous system and account for about 15-20% of all neuro-oncological diagnoses. These tumors are most often detected in women, especially in the age group from 30 to 70 years. Meningiomas can be asymptomatic and discovered incidentally during neuroimaging studies such as CT or MRI, but as they increase in size, neurological symptoms associated with compression of surrounding tissues may occur.

History of the disease and interesting historical facts

Meningioma has been mentioned since ancient times. In the 19th century, the founders of neurosurgery, such as Virchow and Fallopius, began to study the pathology of the skin and meninges, which became the basis for the study of meningiomas. One of the first successful removals of meningioma is considered to be an operation performed at the beginning of the 20th century, which led to a revolution in the neurosurgical approach to the treatment of tumors of the central nervous system. It is interesting that meningioma was first described in 1761, when the Italian anatomist Giacomo Bernardo Visconti mentioned a “soft tumor of the brain.” Over time, the number of cases and treatment methods studied increased, which contributed to the development of modern approaches to diagnostics and surgery.

Epidemiology

Meningiomas are a relatively common disease, especially among adults. According to various epidemiological studies, their incidence varies, but averages 5-7 cases per 100,000 people per year. These tumors tend to occur more often in women, the ratio of women to men is approximately 2:1, in some studies this ratio reaches 3:1. According to literary sources, meningiomas are most often diagnosed at the age of 40-70 years, but they also occur in young people, including children. At the same time, a significant number of meningiomas remain asymptomatic, which makes it difficult to represent them in statistics.

Genetic predisposition to this disease

Studies show that genetic predisposition to meningiomas may be due to mutations in a number of genes, the most important of which is the NF2 (neurofibromatosis type 2) gene. Mutations in this gene result in dysfunction of the merlen protein, which contributes to the development of tumors. In addition, an association with Cone syndrome has also been studied. Other genes involved, potentially associated with the development of meningiomas, are the CDKN2A and TP53 genes, as well as mutations affecting signaling in the PI3K/Akt pathway, responsible for cell growth and development. However, it should be noted that most cases of meningiomas do not have a clear hereditary predisposition.

Risk factors for the development of this disease

There are various risk factors that can contribute to the development of meningiomas. Key factors include the following:

• Radiation to the head or neck (especially as part of treatment for tumors).
• History of neurological diseases, including brain damage.
• Family history of meningomas and other CNS tumors.
• Exposure to certain chemicals, such as formaldehyde.
• Hormonal factors, including the use of hormonal drugs.

Each of these factors may increase the likelihood of developing meningioma, but their presence does not necessarily lead to the development of the disease, and in most cases meningiomas occur spontaneously.

Diagnosis of this disease

Diagnosis of meningioma often begins with a clinical examination, including history taking and neurological examination. The main symptoms in the early stages may be nonspecific and include headaches, seizures, cognitive impairment, behavioral changes, and limb weakness.

To establish a diagnosis, the following diagnostic methods are necessary:

• Laboratory tests: In general, laboratory tests are not specific for meningiomas but may be useful in excluding other conditions.
• Radiological examinations: Magnetic resonance imaging (MRI) is the gold standard in visualizing meningiomas, allowing for accurate determination of their location, size, and nature.
• Other types of diagnostics: Computed tomography (CT) scans may also be used, especially in emergency cases.
• Differential diagnosis: It is important to distinguish meningiomas from other non-neoplastic lesions such as gliomas and metastases.

Thus, modern diagnostic methods allow for accurate and effective identification of meningiomas.

Treatment

Treatment for meningiomas can vary depending on the size, location of the tumor, and the presence of symptoms. The main treatments are:

• General treatment: In cases where the meningioma does not cause obvious symptoms or is rapidly growing, a “wait and see” strategy with regular monitoring may be chosen.
• Pharmacological treatment: There are no specific antitumor drugs for meningiomas, but symptomatic medications are used to relieve pain and other symptoms.
• Surgical treatment: the most effective method for removing meningiomas, especially if they cause compression of surrounding structures.
• Other types of treatment: If surgical intervention is not available, radiosurgical methods such as the gamma knife can be used.

Thus, the choice of treatment depends on the individual characteristics of the patient and the characteristics of the tumor itself.

List of medications used to treat this disease

In most cases, pharmacology is not used specifically for the treatment of meningiomas, since surgery is the main method. However, the following drugs can be used for symptomatic treatment:

• Painkillers (eg paracetamol, nonsteroidal anti-inflammatory drugs).
• Antiepileptic drugs (eg, valproic acid).
• Corticosteroids to reduce swelling around the tumor (eg, dexamethasone).

These agents are used depending on the clinical situation and the patient's condition.

Disease monitoring

After treatment, neurosurgery requires continuous monitoring of the patient's condition. Monitoring steps may include:

• Regular neuroimaging studies (MRI or CT) at regular intervals to detect possible relapses.
• Assessment of neurological functions and general condition of the patient.
• Monitoring of symptoms associated with the localization of meningioma.

The prognosis for timely diagnosis and treatment of meningiomas is generally favorable. However, complications may develop, including relapse of the disease, which requires careful and dynamic monitoring.

Age-related features of the disease

Meningiomas can occur at any age, but there are certain age groups that are more susceptible to this disease:

• Women aged 30-50 years have the highest incidence of meningiomas, which may be related to hormonal changes.
• Meningiomas are less common in children, but are often associated with hereditary syndromes.
• In older people, meningiomas may present more aggressively and require a more intensive treatment approach.

Thus, the approach to treatment and monitoring of meningiomas may vary depending on the patient's age.

Questions and Answers

• What is meningioma? Meningioma is a benign tumor that forms from the cells of the meninges, most often located on the top of the brain.
• What are the symptoms of meningioma? Symptoms may include headaches, seizures, visual disturbances, weakness, and cognitive impairment, but may be absent if the tumor is small.
• How is meningioma diagnosed? The main diagnostic method is MRI, which allows for precise visualization of the tumor and its impact on surrounding tissues.
• How is meningioma treated? Treatment may include surgical removal, as well as radiation therapy and symptomatic drug therapy.
• What is the prognosis after meningioma treatment? The prognosis is generally good, especially with early detection and adequate surgical intervention, but regular monitoring is necessary to prevent relapse.