SPINAL MENINGIOMA

What Causes Meningiomas?

The exact cause of spinal meningiomas, like other forms of meningioma, is not fully understood. However, researchers have identified several key factors that contribute to their development.

• Genetic Mutations: Many meningiomas, including spinal ones, are linked to mutations in specific genes. One of the most common is a mutation affecting chromosome 22, particularly involving the NF2 gene. This gene is responsible for producing a protein that regulates cell growth. When mutated, cells in the meninges, the membranes surrounding the brain and spinal cord, can grow uncontrollably, forming a tumor. These mutations can occur sporadically or be inherited, as seen in genetic conditions like neurofibromatosis type 2 (NF2).  This predisposes individuals to multiple tumors of the nervous system, including meningiomas.
• Radiation Exposure: Another established risk factor is exposure to high doses of radiation, especially during childhood. For instance, individuals who received radiation therapy to the head or neck to treat other conditions, or survivors of atomic bombings, have an elevated risk of developing meningiomas later in life.
• Sex Hormones: Spinal meningiomas are more common in women than men, and researchers believe this may be due to the presence of estrogen and progesterone receptors in many of these tumors. This hormonal influence is supported by the fact that meningiomas often occur more frequently in women, particularly postmenopausal women.
• Age and Gender: Spinal meningiomas predominantly occur in middle-aged and older adults, with the average age of diagnosis around 45-50 years. They are also more common in women, who are about four times more likely to develop these tumors compared to men.
• Other Genetic Syndromes: Individuals with rare genetic conditions such as Von Hippel-Lindau (VHL) syndrome, Turcot syndrome, or Li-Fraumeni syndrome are also at an increased risk of developing spinal meningiomas, along with other tumors.
• Obesity and Other Lifestyle Factors: Emerging research indicates that factors such as high body mass index (BMI), low physical activity, and a history of uterine fibroids may also increase the risk of meningiomas, particularly in women.

While researchers continue to explore the underlying causes of spinal meningiomas, it is clear that both genetic predisposition and environmental factors like radiation play significant roles in their development. However, for many patients, the cause remains idiopathic, meaning no specific cause is identified.

Meningioma Types

While some meningioma varieties develop slowly and do not spread, others grow more rapidly and are more hazardous. There are three different meningioma kinds or grades. A doctor evaluates the grade in light of elements like:

• The location of the tumor.
• A classification of the tumor.
• The size of the spread.
• Genetic results.
• Age of the subject.
• The quantity of tumors that are still present after surgery.

Doctors grade meningiomas from 1 to 3. Grade 1 is the most common type and grows slowly. People with grade 2 meningiomas are more likely to have their tumors come back after surgery to remove the original tumor. Grade 3 meningiomas are the rarest but most serious type. Meningiomas that are Grade 2 and 3 often metastasize or recur, even after surgery. Grade 2 meningiomas can spread from the meninges to the surrounding spine and bone tissue. Grade 3 meningioma can spread to the brain and other organs.

On microscopic inspection, grade 2 meningioma cells show an unusual look — when compared to normal meningeal cells.  Furthermore, those with grade 3 meningiomas show an extremely abnormal look. This is what doctors refer to as an anaplastic look. Meningiomas of higher grades are more prevalent in men than in women, according to the National Cancer Institute. The majority of meningiomas occur in black persons and adults 60 years and older.

Are Spinal Meningiomas Curable?

Our doctors completely remove most meningiomas. If your doctor catches it early and it’s not causing symptoms, you may not need to treat it right away. If the surgeon completely removes a tumor that is graded as a 1, there is a high chance that it will not recur. However, high-grade tumors may recur. Higher-graded meningiomas are more difficult to cure, and if those tumors are malignant, they result in shorter overall survival rates. Following surgery, radiation treatment may increase survival rates and lower the likelihood of regrowth and spreading.

How are Meningiomas Diagnosed?

Meningiomas frequently become known as a result of symptoms a person experiences. The following examinations will identify meningiomas:

Neurological exam

Your doctor may question you about your symptoms and may do a neurological examination to check for any changes in your mood, behavior, vision, coordination, balance, or motor and sensory function.

Imaging

Using an MRI or CT scan to create an image of the spinal cord will help the doctor to identify a meningioma.

Biopsy

In addition, your doctor could decide to take a sample of the tumor so they can look at it under a microscope before determining the diagnosis.

Living with a Meningioma

Meningiomas frequently grow slowly and without any signs in their victims. Experts could advise attentive waiting because of this. This implies that you will inform your healthcare practitioner of any new symptoms. Additionally, in order to monitor even tiny changes in the tumor, he or she will routinely request scans. Doctors use this option for treating small, asymptomatic tumors, especially for older people who cannot undergo surgery or radiation therapy because of other medical conditions.

Treatment

Each spinal meningioma treatment must be customized to the unique circumstances of each patient. For instance, it would probably make sense to only watch a meningioma if it is modest and does not compress the spinal cord. On the other hand, you should definitely consider surgery to preserve and maybe even restore your capacity to function if a meningioma is big, pushing on nerves, and producing signs like paralysis on one side of your body. Thankfully, a number of spinal meningioma treatments can successfully remove the tumor. Also, these treatment choices might range from straightforward monitoring to spine surgery.  And if certain circumstances are present, doctors will recommend radiation to shrink and eliminate the tumor.

Monitoring/Observation

A spinal meningioma may just require simple monitoring, depending on its size, location, and pace of growth. In a patient who fits the following description, doctors will observe the patient.

1. Patients without symptoms or those whose symptoms are not bothersome to the patient
2. Patients who are at high risk due to additional comorbid conditions that are more urgently life-threatening

Surgery

By squeezing the spinal cord or the nearby nerve roots, a meningioma in the spine might result in neurological pain symptoms. The only effective treatment for this structural issue is surgical excision of the spine tumor. The majority of the time, our surgeons can surgically remove an entire meningioma. Even though the operation aims to completely remove the tumor, it is only during surgery that the tumor and any linkages to other tissues occur.

The spinal tumor may have encroached on nearby bones, tissues, or blood vessels while growing around nerves, blood vessels, or the spinal cord. However, if the doctors decide that removing a tumor entirely entails a high risk of morbidity, they might decide to leave some of the tumor attached to vital anatomical structures and then either monitor with imaging tests or advise radiation therapy to stop a recurrence of either a benign or malignant tumor.

Radiation Therapy

Radiation therapy is rarely used to treat spinal meningiomas and uses high-energy rays to destroy cancer cells and abnormal cell growth. Ideally, radiotherapy is considered a viable option when tumor location makes surgery too risky to completely resect the tumor. Also, radiation therapy involves a highly precise, non-invasive dose of radiation directed at the tumor. Modern delivery methods significantly reduce the risk of long-term radiation damage and limit exposure to surrounding anatomy. Commonly used radiotherapy techniques include intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT). These techniques use a specific type of radiation whose protons are focused only on the tumor. The main advantage of these methods is that they are less damaging to the tissue surrounding the tumor.

Chemotherapy

Because of its side effects and associated risks, chemotherapy is rarely utilized for treating spinal meningioma.

Stereotactic Radiosurgery

Stereotactic radiosurgery is a viable alternative treatment option for meningiomas, although it is not a good option for spinal meningiomas. In radiosurgery, a tiny region, such as a tumor, receives a deadly dosage of radiation in a non-invasive, extremely precise manner. This makes it an excellent choice for malignancies in several locations that would be challenging to approach with conventional or microsurgical techniques. Even the most advanced radiosurgery techniques have trouble protecting nearby structures from receiving a considerable dose of radiation. Radiation poisoning of the spinal cord is a legitimate issue since spinal meningiomas are typically so near to the spinal cord.

Rehabilitation and Recovery Periods for Spinal Meningioma Treatments: Surgery, Radiation Therapy, Chemotherapy, and Stereotactic Radiosurgery

Spinal meningiomas are tumors that develop in the membranes (meninges) surrounding the brain and spinal cord. While most spinal meningiomas are benign, their location can lead to significant neurological symptoms due to compression of the spinal cord or surrounding nerves. Treatment approaches vary based on the tumor’s size, location, and behavior. The four primary treatments are surgery, radiation therapy, chemotherapy, and stereotactic radiosurgery (SRS). Each has its own rehabilitation and recovery process, which depends on the treatment’s invasiveness and impact on the body. This paper examines the rehabilitation and recovery periods for each of these treatments, with a special focus on surgical intervention, which is often the first-line treatment for spinal meningiomas.

1. Surgery

Surgery is one of the most common treatments for spinal meningiomas, particularly for tumors causing significant neurological deficits. The goal of surgery is to completely remove the tumor while preserving spinal cord function. The extent of surgery depends on the tumor’s location and size, with the surgeon aiming to minimize damage to surrounding tissues.

Rehabilitation Process

The rehabilitation process following spinal surgery is often the most involved compared to other treatments. Surgery, especially for tumors near critical spinal structures, can cause temporary or permanent nerve damage, muscle weakness, or sensory loss. The intensity of rehabilitation depends on the patient’s preoperative condition, the tumor’s impact on the spinal cord, and the extent of surgical inter

• Early post-surgery care: After surgery, patients typically remain in the hospital for several days to a week for monitoring. During this period, rehabilitation starts with basic mobility exercises to prevent complications such as blood clots or muscle atrophy. Pain management is a key component in the early stages, often involving medications and gentle physical therapy.
• Physical therapy: Post-surgery, physical therapy is crucial to regaining strength, balance, and coordination. Depending on the severity of the nerve damage or spinal cord compression, physical therapy may focus on relearning motor functions, walking, and improving muscle strength.
• Occupational therapy: For patients who experience difficulties with daily activities, occupational therapy may be required. This therapy helps patients adapt to any lasting deficits and regain independence in activities such as dressing, bathing, and mobility.
• Spinal bracing: In some cases, patients may need to wear a spinal brace to support the spine as it heals and to prevent excessive movement that could interfere with recovery.

Recovery Period

The recovery period after surgery for spinal meningiomas can vary widely depending on the complexity of the surgery, the tumor’s location, and the patient’s overall health. While some patients may regain mobility and function within a few weeks, others may take months or longer to fully recover.

• Short-term recovery: In the initial weeks after surgery, patients may experience pain, stiffness, and swelling at the surgical site. Most patients are encouraged to begin walking or light physical activity within a week to promote healing and prevent complications such as deep vein thrombosis (DVT).
• Long-term recovery: Full recovery may take 3 to 6 months or longer, depending on the severity of nerve damage or spinal cord involvement. During this time, patients may continue with physical and occupational therapy to restore function. Neurological symptoms such as numbness or weakness may persist for months and, in some cases, may be permanent if significant nerve damage occurred before or during surgery.

2. Radiation Therapy

Radiation therapy uses high-energy radiation to target and kill cancer cells or shrink tumors. It is often used when surgical removal is not possible, when a tumor is incompletely resected, or as an adjunct to surgery to reduce the risk of recurrence.

Rehabilitation Process

Rehabilitation for patients undergoing radiation therapy primarily focuses on managing side effects such as fatigue, skin irritation, and neurological symptoms resulting from damage to the spinal cord or surrounding tissues.

• Physical therapy: Patients may need physical therapy to address muscle weakness, balance issues, or fatigue caused by radiation-induced damage to nearby tissues.
• Pain management: Some patients experience pain due to inflammation caused by radiation. Rehabilitation may include techniques to manage pain and maintain mobility during and after treatment.

Recovery Period

The recovery period from radiation therapy typically lasts several weeks to months, depending on the patient’s overall health and the extent of radiation exposure. Fatigue is the most common side effect, and it can persist for weeks after completing treatment.

• Short-term recovery: In the immediate weeks following radiation therapy, patients may experience fatigue and localized pain. Physical activity is encouraged to help patients regain strength and reduce the impact of side effects.
• Long-term recovery: Radiation can lead to late-onset side effects such as fibrosis (scarring) or radiation myelopathy. Full recovery from these effects may take months, and some patients may need ongoing rehabilitation to manage long-term complications.

3. Chemotherapy

Chemotherapy is not a standard treatment for benign spinal meningiomas but may be used for malignant or recurrent tumors. It involves using drugs to destroy or slow the growth of cancer cells. Chemotherapy can cause significant systemic side effects, affecting healthy cells along with cancerous ones.

Rehabilitation Process

Patients undergoing chemotherapy may experience a variety of side effects, such as neuropathy (nerve damage), muscle weakness, and cognitive impairments, all of which can impact rehabilitation.

• Physical therapy: Rehabilitation may focus on addressing neuropathy, which can cause balance issues, muscle weakness, or numbness in the limbs. Strength-building exercises are key in restoring mobility and preventing falls.
• Cognitive therapy: Some patients experience cognitive impairments, often referred to as “chemo brain,” affecting memory and concentration. Cognitive rehabilitation may be necessary to help patients cope with these challenges.

Recovery Period

Recovery from chemotherapy varies depending on the drugs used, the dosage, and the patient’s overall health. The acute side effects of chemotherapy typically resolve within a few weeks to months after the last dose, but some side effects, such as neuropathy or cognitive changes, can persist longer.

• Short-term recovery: During the first few weeks after chemotherapy, patients may experience significant fatigue, nausea, and weakness. Physical activity may be limited initially, but light exercise and physical therapy can help with recovery.
• Long-term recovery: Full recovery from the effects of chemotherapy may take several months. Patients may require ongoing therapy to manage long-term side effects, such as neuropathy or cognitive deficits.

4. Stereotactic Radiosurgery (SRS)

Stereotactic radiosurgery (SRS) is a highly precise, non-invasive radiation treatment that delivers focused radiation to a tumor in one or a few sessions. It is an excellent option for small, well-defined tumors or patients who cannot undergo surgery.

Rehabilitation Process

Since SRS is a non-invasive treatment, the rehabilitation process is typically less intensive than that for surgery or chemotherapy. Rehabilitation primarily focuses on managing any neurological symptoms caused by the tumor or temporary side effects of radiation.

• Physical therapy: Patients with pre-existing neurological deficits may need physical therapy to regain strength, balance, and coordination.
• Pain management: Inflammation or swelling following SRS may cause temporary discomfort. Pain management strategies and physical therapy can help address these symptoms.

Recovery Period

The recovery period for SRS is generally shorter than other treatments, with most patients resuming normal activities within a few days to a week. However, follow-up care is essential to monitor for delayed side effects such as radiation necrosis (death of healthy tissue due to radiation).

• Short-term recovery: Patients may experience mild fatigue or localized swelling, but these side effects usually resolve within a few weeks.
• Long-term recovery: Full recovery can take several months as the body absorbs the treated tumor tissue. Regular follow-up imaging is important to assess the tumor’s response to treatment and ensure no late-onset complications occur.

Conclusion

Rehabilitation and recovery periods for spinal meningiomas depend heavily on the treatment modality chosen. Surgery often involves the most extensive rehabilitation due to the risk of nerve damage and the physical trauma of the procedure. In contrast, stereotactic radiosurgery offers a quicker recovery period but still requires careful follow-up to monitor long-term effects. Radiation therapy and chemotherapy each have systemic side effects that may prolong the rehabilitation process. A multidisciplinary approach, including physical therapy, occupational therapy, and ongoing medical follow-up, is crucial in optimizing recovery and improving the patient’s quality of life.

Southwest Scoliosis and Spine Center Expertise

Here at the Southwest Scoliosis and Spine Institute, we have a team of experts and specialists that focuses on diagnosing and treating scoliosis and other spinal deformities. We routinely conduct spinal surgery and revision surgery for children and adults.

Finally, your spine treatment team at the Southwest Scoliosis and Spine Institute with offices in Dallas, Plan, and Frisco, Texas has appointments within 24 hours to treat the most complicated and sophisticated spine problems. Our specialists are always ready to speak with you. So, call us today at 214-556-0555 to schedule an appointment with our team.

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National Institute of Health: Spinal Meningioma