A meningioma is usually a benign, slow-growing tumour, and not every meningioma needs surgery. Small meningiomas found by chance are often safely watched with MRI scans, while those causing symptoms or growing are usually treated by surgical removal, sometimes followed by radiotherapy. Patients in Lahore with a newly found meningioma can be reassured that there is usually time to make a careful, informed decision.
Meningiomas arise from the meninges, the thin layers covering the brain and spinal cord. They grow from the covering rather than from the brain itself, and they press on the brain rather than invading it in most cases.
Meningiomas are among the most common tumours inside the head, and are more common in women and in middle and older age. The World Health Organization (WHO) grades them in three groups:
The grade is only known for certain after the tissue is examined under the microscope.
Because meningiomas grow slowly, the brain often adapts and symptoms come on gradually. Small ones frequently cause no symptoms at all.
Seek urgent medical help for a first seizure, sudden severe headache, new weakness, confusion, drowsiness or rapidly worsening vision.
Most meningiomas have no identifiable cause. Known risk factors include previous radiation to the head, and the inherited condition neurofibromatosis type 2. Female hormones are also thought to play some role. They are not caused by mobile phones, stress or head injury.
MRI with contrast is the main test. A meningioma typically appears as a well-defined mass attached to the covering of the brain, often with a "dural tail". MRI also shows any swelling (oedema) of the nearby brain and the relation to veins and nerves. A CT scan helps assess calcium in the tumour and any bone thickening. For tumours near major veins or with a rich blood supply, an angiogram may be done, sometimes with embolisation to reduce bleeding at surgery. Eye or hearing tests are added depending on the site.
Many small meningiomas found incidentally, especially in older patients and those without swelling of the brain, can simply be monitored. A repeat MRI is usually done after several months, then at longer intervals if the tumour is stable. Many never grow enough to need treatment.
Surgery is the main treatment for meningiomas that are causing symptoms, growing, or surrounded by brain swelling. Most are removed through a craniotomy: a window of bone is lifted, the tumour is separated from the brain under the operating microscope, and the bone is replaced. Neuronavigation may be used to plan the opening precisely.
Surgeons describe how complete the removal was using the Simpson grade. In plain words: the most complete removal takes out the tumour, the patch of covering it grew from, and any affected bone, which gives the lowest chance of recurrence. Where the tumour is stuck to important nerves, arteries or major venous sinuses, it is often safer to leave a small piece behind rather than risk a new disability. That remaining piece can then be watched or treated with radiation.
Some meningiomas at the base of the skull, particularly around the pituitary and optic nerves, can be removed through the nose by endoscopic brain surgery. These complex cases are described on our skull base tumour surgery page.
Stereotactic radiosurgery or fractionated radiotherapy may be used for small tumours in difficult locations, for residual tumour after surgery, for regrowth, and routinely after surgery for many grade 2 and all grade 3 meningiomas. Radiation aims to stop growth rather than make the tumour disappear.
Patients who have had seizures are treated with anti-seizure medication. Many can reduce or stop this some months after successful surgery, under medical guidance. Local driving advice after a seizure should be followed.
After a craniotomy, many patients stay in hospital for around three to seven days. Headache and tiredness are common for several weeks. Many people return to office work in about four to eight weeks, but this depends on the tumour location and how they were before surgery. Steroids are often tapered over a few days to weeks. A follow-up MRI is usually done a few months after surgery, then periodically for many years, since even benign meningiomas can occasionally recur.
Risks depend heavily on location and size. They include bleeding, infection, seizures, brain swelling, CSF leak, blood clots in the legs, new weakness, speech or vision problems, and injury to nearby nerves for skull base tumours. Some tumours regrow. Dr. Khawar Anwar will explain the specific risks for your tumour's position before any decision. More on other tumour types is on our brain tumour surgery page.
Most meningiomas are grade 1 and benign. They do not spread through the body. A small proportion are atypical or malignant and need closer follow-up and additional treatment.
Not necessarily. Small meningiomas without symptoms are often monitored with MRI scans. Surgery is considered if the tumour grows or starts causing symptoms.
Yes, it can, especially if part of the tumour had to be left or if it is grade 2 or 3. Regular MRI follow-up allows any regrowth to be found early and treated.
Many patients have fewer or no seizures after removal of the tumour, but some continue to need medication. Your doctors will guide when it is safe to reduce it.
Bring all MRI and CT scans (the films or CD, plus reports) and any previous scans for comparison. You can book an appointment online.
Dr. Khawar Anwar is a Consultant Neurosurgeon & Spine Surgeon at PINS / Lahore General Hospital, Lahore, with over 10 years of experience in brain and spine surgery. He sees patients in Lahore and Gujranwala and focuses on minimally invasive and endoscopic techniques where they are suitable for the patient.
See the full list on the certifications page or read more about Dr. Khawar Anwar.
See all clinics, maps and timings on the locations page.
To book, call or WhatsApp 0333-7574732 and tell us which clinic and day suits you. Please bring your MRI or CT scan (films and CD), reports and a list of your current medicines to the consultation. For sudden weakness, loss of bladder or bowel control, a sudden severe headache or a head or spine injury, go to the nearest emergency department first.