Dr. Sadai on Signs and Symptoms of High-Grade Meningiomas

Although meningiomas, tumors that arise in the meninges surrounding the brain and spinal cord, are the most common form of primary brain tumors. Grade I tumors are often asymptomatic, and patients can live for years without problems. High-grade meningiomas, however, are rare and aggressive tumors. Nader Sanai, MD, chief scientific officer and chief of neurosurgical oncology with the Ivy Brain Tumor Center at the Barrow Neurological Institute, says about 5% of high-grade tumors represent the malignant grade III form of the disease.

Meningiomas are graded as I, II, or III. Grade 1 tumors are often small, benign, and indolent. In many cases, patients with grade I tumors can do not need immediate treatment and can simply be observed. When treatment is necessary, surgery with or without radiation can often completely resolve these tumors.

Sanai says that grade II tumors are more aggressive, though not technically considered malignant. However, they have a high incidence of recurrence. Sanai says that symptom onset in grade II/III tumors is much more rapid, but those symptoms can be nonspecific. Sanai said higher-grade tumors can be diagnosed with a CT scan but are more often detected on MRI.

The most common symptoms include headache, focal cranial nerve deficit, and seizure. Depending on the site of the tumor, high-grade meningiomas can also cause focal neurologic deficits including cranial nerve deficits. The patient may experience posterior fossa type syndromes such as nausea, vomiting, balance problems, or double vision if the tumor is closer to the cerebellum.

High-grade meningiomas can also present with progressive symptoms, such as new onset focal neurological deficits, significant headache, or mass effect symptoms such as fatigue, vision problems, or nausea and vomiting. Sanai noted that the rapid growth of grade II/III tumors causes swelling in the brain, leading to seizures.