What is a Meningioma?

A meningioma is the most common benign (non-cancerous) brain tumour in adults. It arises from the meninges, the protective membranes surrounding the brain and spinal cord, rather than from the brain itself.

Approximately 90% of meningiomas are benign (WHO Grade I) and typically grow slowly over many years. Most are not life-threatening and many never require treatment.

Meningiomas are often discovered incidentally during MRI scans performed for unrelated reasons such as headaches, dizziness or after a minor head injury. Others are diagnosed after causing symptoms by pressing on the brain, cranial nerves or spinal cord.

Although hearing the words “brain tumour” can be frightening, it is important to remember that many meningiomas remain stable throughout life. The challenge is determining which tumours can be safely observed and which are most likely to benefit from treatment.

What Happens if a Meningioma is Left Untreated?

One of the first questions following diagnosis is whether the tumour will continue to grow.

The answer is not always.

Many meningiomas remain unchanged for years and never cause symptoms. Others enlarge gradually over time and may eventually produce symptoms because of pressure on the surrounding brain or nerves.

Current evidence suggests that most incidental meningiomas grow slowly, although growth rates vary considerably between individuals.

Factors associated with an increased likelihood of tumour growth include:

• Larger tumour size
• Younger patient age
• Surrounding brain swelling (oedema)
• Certain tumour locations
• Specific MRI characteristics
• Documented growth on serial imaging

No single factor predicts future behaviour. Treatment decisions therefore require careful assessment of the tumour together with each patient’s symptoms, age, overall health and long-term outlook.

How is a Meningioma Diagnosed?

Most meningiomas are diagnosed using MRI with gadolinium contrast, which provides detailed information regarding tumour size, location and its relationship to surrounding brain structures, cranial nerves and major blood vessels.

CT scanning may also be helpful to assess calcification or involvement of the skull.

These imaging findings help determine whether observation, surgery or radiotherapy is likely to provide the greatest long-term benefit.

Do All Meningiomas Need Treatment?

No.

Not every meningioma requires treatment.

For many patients, careful observation with regular MRI surveillance provides the safest long-term strategy.

Treatment is generally recommended when the tumour demonstrates continued growth, causes neurological symptoms, compresses important brain structures or is likely to become more difficult to treat if left untreated.

Every treatment recommendation should therefore be individualised.

What Are the Treatment Options?

Several effective treatment options are available, and many patients benefit from assessment by a multidisciplinary brain tumour team involving neurosurgeons, radiation oncologists, neuroradiologists and other specialists.

Observation

Many incidental meningiomas can be managed safely with regular MRI surveillance.

Observation avoids unnecessary treatment while allowing tumour behaviour to be monitored over time.

Microsurgical Removal

Microsurgical removal remains the definitive treatment for symptomatic or enlarging meningiomas.

The goals of surgery include:

• complete tumour removal where safe
• preservation of neurological function
• relief of symptoms
• minimising the risk of recurrence

Depending on the tumour’s location, complete removal may not always be possible if important nerves or blood vessels are involved. In these situations, maximal safe tumour removal followed by observation or radiotherapy may provide the best long-term outcome.

Stereotactic Radiosurgery

Stereotactic radiosurgery (Gamma Knife or LINAC) uses highly focused radiation to stop tumour growth.

It is commonly recommended for selected small tumours, residual tumour following surgery or recurrent meningiomas, providing excellent long-term tumour control without open surgery.

Fractionated Radiotherapy

Fractionated radiotherapy may be recommended following surgery for atypical (WHO Grade II) or malignant (WHO Grade III) meningiomas, or when complete tumour removal is not possible.

Which Treatment is Best?

There is no single treatment that is appropriate for every meningioma.

The most appropriate management depends on the tumour’s size, location, growth pattern, relationship to surrounding brain structures, patient age, symptoms, overall health and long-term goals.

Some meningiomas are best managed with careful observation. Others are ideally treated with microsurgical removal or radiotherapy.

The goal is not simply to remove the tumour, but to recommend the treatment that offers the greatest long-term benefit while preserving neurological function and quality of life.

Why Seek an Early Specialist Opinion?

Every newly diagnosed meningioma deserves expert assessment.

Early specialist review helps determine the likelihood of future tumour growth, explains the available treatment options and establishes whether observation or treatment is the most appropriate strategy.

For many patients, understanding the natural history of their tumour and discussing all available management options provides reassurance and confidence moving forward.

Why Choose Professor Lai?

Meningiomas vary enormously in their location, growth pattern and complexity. While many tumours can be managed safely with observation, others require carefully planned microsurgical removal or radiotherapy. Determining the most appropriate treatment requires careful assessment of the tumour together with each patient’s symptoms, age, overall health and long-term goals.

Professor Lai has a dedicated brain tumour and skull base practice with extensive experience managing meningiomas throughout the brain, including many arising around the skull base where surgery is particularly demanding. Treatment recommendations are individualised and may include observation, microsurgical removal, stereotactic radiosurgery or a combination of treatments, depending on the characteristics of the tumour and each patient’s circumstances.

Working closely with radiation oncologists and other specialists, Professor Lai develops multidisciplinary treatment strategies focused on preserving neurological function while achieving durable tumour control.

Patients are referred from across Melbourne, regional Victoria, throughout Australia and overseas for both primary treatment and complex second opinions. Every recommendation is guided by sound clinical judgement, the best available evidence and a commitment to recommending the right treatment for the right patient.

Frequently Asked Questions

Is a meningioma cancer?

No. Meningiomas are generally not considered brain cancers. More than 90% are benign (WHO Grade I) tumours that grow slowly and often have an excellent long-term prognosis.

A smaller proportion are classified as WHO Grade II (atypical) or, more rarely, WHO Grade III (anaplastic). These higher-grade tumours have more biologically aggressive features, are more likely to grow or recur after treatment, and may require additional therapies such as radiotherapy following surgery.

The tumour grade can only be confirmed by microscopic examination after surgical removal or biopsy.

Will my meningioma continue to grow?

Not necessarily. Many meningiomas remain stable for years, while others enlarge gradually over time. Regular MRI scans help monitor tumour behaviour.

Will I definitely need surgery?

No. Many patients can be managed safely with observation alone. Surgery is recommended only when the expected benefits outweigh the risks.

Can a meningioma be cured?

Yes. Many benign meningiomas can be completely cured with surgery. Others can be effectively controlled with radiotherapy or long-term observation.

Can a meningioma come back after surgery?

Recurrence depends on the tumour grade and whether complete removal is possible. Benign meningiomas that are completely removed have a relatively low risk of recurrence, although long-term follow-up is often recommended.

How often will I need MRI scans?

The frequency of MRI surveillance depends on the size, location and behaviour of the tumour, together with your age and overall health. Your neurosurgeon will recommend an individual follow-up schedule.

Should I get a second opinion?

Yes. Because many meningiomas can be managed safely without immediate treatment, specialist assessment can help clarify the natural history of the tumour and determine whether observation, surgery or radiotherapy is likely to provide the greatest long-term benefit.

Most meningiomas are benign and many never require treatment. The most important decision is not how quickly to operate, but whether treatment is needed at all. Careful assessment by an experienced neurosurgeon is the first step towards understanding your tumour and selecting the treatment that offers the best long-term outcome.

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