Treatment of Meningioma of the Spine in New Jersey

The brain and spine are covered by a continuous thin layer of neurological tissue called the meninges. If a tumor forms from the meninges, it is classified as a meningioma. In the majority of cases, whether it grows in the brain or the spine, a meningioma is benign. Only a small percentage become cancerous. Though the most prevalent type of spine tumor is a metastatic spine tumor, a spine meningioma is the second most common type of spine tumor. It is also the second most common type of intradural extramedullary spinal tumor accounting for 25-30% of all such spine tumors. Most spine meningiomas grow in the cervical region of the neck or in the thoracic region. Notably, these tumors seldom grow in the lower back or the lumbar area. Even though a meningioma may not be cancerous, it can still cause significant dysfunction and discomfort. If allowed to continue to grow, meningiomas can lead to paralysis and become life threatening.

At the Centers for Neurosurgery, Spine & Orthopedics, we work with a team of board-certified neurosurgeons which are the only qualified surgeons to diagnose, safely remove, and monitor spine meningioma cases. Call to learn more about the treatment of spine meningioma and how CNSO can help.

Symptoms

A meningioma is often an incidental finding on MRI imaging of the brain, neck or spine. Typically, this type of brain tumor grows slowly without the patient having any symptoms of its growth. Mild associated symptoms begin to occur as the spine tumor burden increasingly compresses adjacent nerves, the spinal cord, or blood vessels. Initial symptoms can easily be minimized or attributed to age or other medical conditions by the patient.

Spinal meningioma symptoms may include:

Difficulty walking and maintaining balance
Back pain
Neck pain
Leg Pain
General weaknesses
Gait Disturbances
Muscle spasms of the arm(s) or leg(s)
Paresthesia
Loss of bladder or bowel control

These symptoms begin to occur as the tumor increasingly presses on the spinal nerves or the spinal cord. Again, the symptoms may be subtle at first. Consequently, an early diagnosis at the initial stages of tumor growth usually is an incidental finding detected by CT or MRI imaging.

Spinal meningiomas are significantly more common in women. It is not clear exactly what causes a meningioma, but progesterone and estrogen have been associated with tumor growth. Studies have shown that meningeal tumors have abnormalities in the NF2 gene which produces the merlin protein that normally inhibits cell growth. Abnormalities in the protein survivin which normally allows programmed cell death has also been detected. Radiation treatment has an associated increased incidence of spine meningiomas in individuals approximately 20 years after exposure.

Causes & Risk Factors

Although the cause of a spinal meningioma has not been identified, several recognizable risk factors are associated with the tumor. The risk of meningioma generally increases with age. The specific risk factors include:

Radiation Treatment vs. Radiation Exposure

Radiation therapy involving radiation to the head and spine may increase the incidents of spinal meningioma. Exposure to ionizing radiation, especially in high doses, has been associated with a higher incidence of spine meningioma and other intracranial tumors. The occurrence of a meningioma after radiation exposure is typically 20 years thereafter.

In the US, dental x-rays are leading sources of exposure to ionizing radiation. Studies reveal there could be a link between the number of full mouths dental radiographs and the risk of meningioma.

Female Hormones

As mentioned earlier, meningioma is more common in women. The Brain Science Foundation revealed an increased occurrence of meningioma in post-pubertal women compared to men. Researchers believe female hormones may play a more significant role in increasing risks of getting the diseases. Some studies suggest there could be a link between breast cancer and meningioma risk due to expression of female hormones gene production and the HER2 gene produced by a spinal meningioma. Researchers are currently exploring the possibility of a connection between meningioma risk and the use of oral contraceptives and hormone replacements.

Inherited Nervous System Disorder

Studies reveal neurofibromatosis 2 disorder (NF2) increases the risk of meningioma and other brain tumors. Patients with NF2 may also develop malignant or multiple meningiomas.

Obesity

A higher BMI is a major risk factor for many cancers, including meningioma. Several studies have observed a substantial increase in spinal meningioma cases among the obese. However, scientists are yet to discover a clear relationship between meningioma and weight gain.

Diagnosis

The American Association of Neurological Surgeries reveals, unlike other cancers, diagnosing spinal meningioma can be a challenge due to several reasons. First, meningioma is a slow-growing tumor that primarily affects adults. The symptoms are also subtle, and patients may attribute them to the normal signs of aging and other medical conditions. Because of the rarity of a spinal meningioma, misdiagnosis is common until an MRI image of the spine is performed.

The following are some of the common diagnostic methods of meningioma of the spine:

Neurological Evaluation

If a patient shows signs of neck or back pain, radicular arm or leg pain or paresthesias, weakness, loss of movement or function of bowel or bladder doctors will carry out a thorough neurological evaluation followed by ordering the appropriate radiological studies.

The imaging studies used to diagnose spinal meningioma include:

Computed tomography (CT or CAT scan)
Magnetic resonance imaging (MRI)
Magnetic resonance spectroscopy (MRS)

Conducting a Biopsy

The analysis of tissue from a tumor specimen is the only way to make a definitive diagnosis of spinal meningioma. Neurosurgeons are the only type of doctors that can perform a biopsy or completely remove a spine tumor. The specimen will be analyzed at a pathology laboratory by a neuropathologist. The evaluation process will confirm the type of tumor and whether it is benign or malignant. Further necessary clinical management will be based on the results of this analysis.

Treatment

Fortunately, several spinal meningioma treatments can effectively cure the tumor. Depending on the symptoms the patient is experiencing, these treatment options can range from simple monitoring to spine surgery if symptomatic to radiation therapy if cancerous.

Monitoring/Observation

Simple monitoring a spinal meningioma, depending on the size, location, and growth rate is a possibility. Observation over a given period may be the ideal course of action in a patient who meets the following criteria:

Patients with no symptoms or symptoms that are not problematic for the patient
Patients who face significant risk because of other life-threatening comorbidities which take precedent

Surgery

A spine meningioma can causes neurological symptoms, by compressing the spinal cord or the surrounding nerve roots. Because is this a structural problem, the necessary treatment is the surgical removal of the spine tumor . Most of the time, CNSO neurosurgeons can completely remove a spine meningioma via spine surgery. Though the goal of the surgery is to remove the tumor in its entirety, it is only at the time of surgery that the tumor and any attachments to the surrounding structures can be fully appreciated. The spine tumor may have grown around nerves, blood vessels or the spinal cord attaching to the surrounding tissues and bones. This seldom happens in the case of a spine meningioma. But if the surgeons determine a complete removal of a tumor carries a significant risk of morbidity, they may leave some of the tumor attached to critical anatomical structures then either monitor via imaging studies or recommend radiation therapy to prevent reoccurrence whether benign or malignant.

Radiation Therapy

Radiation therapy, though seldom used to treat a spine meningioma, leverages high-energy X-rays to destroy cancer cells and abnormal cell growth. Ideally, radiation therapy is considered a viable option if it the location of the tumor poses too high of a risk to completely remove the tumor via surgery. Radiation therapy involves a highly accurate, non-invasive dose of radiation to be directed at the tumor. Modern delivery methods reduce the risk of long-term radiation injury substantially and limit the exposure to the surrounding anatomical structures. Some of the commonly utilized radiation therapy techniques include Intensity-Modulated Radiotherapy (IMRT) and 3-Dimensional Conformal Radiotherapy (3DCRT). These methods employ a specific type of radiation where protons are directed specifically at the tumor. The main benefit of these technologies is that less tissue near the tumor incurs damage.

Chemotherapy

Chemotherapy may be preferred in cases where malignant subtypes cannot be adequately treated with surgery or radiation therapy. Chemotherapy is rarely used to treat spinal meningioma due to its side effects and associated risks.

When to See a Doctor

As mentioned earlier, typical signs and symptoms of spinal meningioma may evolve slowly. However, there are times when the tumor requires emergency care. If you have persistent signs and symptoms of spinal meningioma that concern you, such as back pain, radicular arm or leg pain, gait disturbances, loss of balance, clumsiness, loss of bladder or bowel function, it may be advisable to see a doctor immediately.

Can You Live a Long Life with Meningioma?

Today, most adults diagnosed with a meningioma of the spine survive and live a full life if they are properly treated. A symptomatic tumor needs to be removed to ensure longevity and quality of life.

Quality Treatment of Meningioma of the Spine in New Jersey

New Jersey has the Centers for Neurosurgery, Spine & Orthopedics (CNSO) team of renowned, board-certified neurosurgeons highly experienced at detecting brain and spine disease. CNSO surgeons provide high quality care and treatment for spinal meningiomas as well as any other type of brain or spine tumor. The dedicated team at CNSO is committed to providing comprehensive and coordinated care so patients experience a quick recovery and can have a better quality of life. New Jersey patients can learn more about options for effectively treating a spine meningioma by contacting CNSO today.