The 'Silent Tumour' of the Brain...

...primarily because it can develop 'silently' for years, is the meningioma. Let us discuss these, as they represent the most common primary brain tumours.

Meningiomas account for approximately 20-30% of all intracranial tumours and originate from the meninges – the membranous coverings that protect the brain and spinal cord.

In 85-90% of cases, they are benign (WHO grade I), grow slowly, compress rather than infiltrate the brain, and often remain stable for years. Rarely, they are atypical (grade II, 20-30%) or malignant (grade III, <2%), with faster growth and higher recurrence risk.

Risk Factors and Epidemiology

They occur more frequently in women (twice as common as in men), particularly aged 40-60 years, though they can arise at any age, including in children or the elderly. They are associated with prior radiotherapy, excessive X-ray exposure, female hormones (acceleration during pregnancy), and hereditary conditions such as neurofibromatosis type II, but the exact causes remain unknown. Approximately 30% of cases are incidentally detected on imaging for other reasons, such as trauma, while multiple meningiomas occur in <10%.

Symptoms and Clinical Picture

Many meningiomas remain asymptomatic for years, but when they grow, they cause symptoms depending on location (e.g. pineal region, skull base, spinal cord). Common symptoms include:

• Progressive worsening headache.

• Epileptic seizures or convulsions.

• Nausea, vomiting, visual changes (diplopia, blurred vision).

• Limb weakness, hearing loss, speech or balance disturbances.

• Changes in behaviour, memory, or cognitive function.In the spine, they cause back pain or neurological deficits.

  
  

Diagnosis

Diagnosis begins with history-taking and neurological examination, followed by imaging: MRI with contrast for detailed position/size assessment, and CT for bony structures. Surgical biopsy confirms histological grade (I, II, III) and malignancy.

Treatment and Prognosis

Treatment is personalised based on size, location, symptoms, age, and grade:

• Observation: For small, asymptomatic cases (MRI every 6-12 months).

• Surgical resection: First-line option, ideally gross total (Simpson grade I, <9% recurrence).

• Radiotherapy/stereotactic radiosurgery: For residuals, inaccessible sites (SRS, SRT, IMRT), or atypical/malignant cases.

• Chemotherapy: Rare, in research protocols for refractory cases.

Prognosis is excellent for benign tumours (5-year survival >90%), with long-term follow-up due to possible recurrence decades later.

Photo resource: Gaillard F, Silverstone L, Walizai T, et al. Meningioma. Reference article, Radiopaedia.org (Accessed on 11 Dec 2025) https://doi.org/10.53347/rID-1659