Spinal Meningiomas: Symptoms And Treatment

Introduction

Characteristics of spinal meningiomas

A spinal meningioma is a type of tumour that arises from the spinal meninges,¹ which are thin layers of tissue that cover the spinal cord, keeping the spinal cord in place, protecting it from any traumatic injuries, and producing cerebrospinal fluid.² These tumours are normally benign (non-cancerous), and are more commonly seen in people assigned female at birth (AFAB), particularly those aged between 60 and 80 years.¹ The exact cause of spinal meningiomas is currently unknown, but there are several risk factors that are suggested as contributing to the development of spinal meningiomas, 

such as genetic predisposition, exposure to radiation, traumatic spinal cord/head injuries, and hormonal influences.³

The importance of understanding symptoms and treatment options

It is important to be able to recognise symptoms of spinal meningiomas and understand how to treat them so that patients can make well-informed decisions about their healthcare. Due to the slow growth of tumours, their location, and the size of the tumour, individuals may show long periods of symptoms before a diagnosis. However, there are some symptoms, such as back pain, sensory changes (numbness/tingling), weakness, altered gait with difficulty in walking, loss of bladder/bowel control, and in severe cases, paralysis that commonly occur.⁴ Treatment options are required to either remove the tumours or treat the patient’s current symptoms.

Symptoms of spinal meningiomas

Overview of common symptoms

• Back pain – back pain either localised or radiating throughout the back, which can vary in intensity. It can also be persistent, intermittent, or worsen over time 
• Weakness or numbness in the extremities – compression or irritation of the spinal cord or nerve roots by the tumour can cause the limbs (arms and legs) to become weak and numb (due to loss of sensation and nerve input to muscles) 
• Difficulty walking or balancing – as mentioned above, disturbance of the spinal cord or nerve roots by the tumour can lead to a loss of coordination, muscle strength, and the balance control needed for walking 
• Bladder or bowel dysfunction – in some cases, the tumour can affect the nerves that control bladder and bowel function, which often leads to difficulty with urination and/or defaecation difficulty and loss of control 
• Changes in sensation – compression of the spinal cord or the nerve roots can lead to disturbances in sensation as signals are blocked from going to the brain via the spinal cord⁴

Diagnosis of spinal meningiomas

Detection and diagnosis of spinal meningiomas are important in order to understand where the tumour is located so treatment options can then be decided accordingly. Diagnosis is commonly achieved through an evaluation of medical history, physical examination, and through imaging techniques. Once diagnosed with spinal meningiomas, the patient can have as their treatment options either observation and monitoring, surgery, radiation therapy, medication, or rehabilitation. 

Components of diagnosis: 

• Medical history and physical examination – firstly, the patient’s medical history should be evaluated, taking particular note of their symptoms, previous medical conditions, and treatments they have received. Then, a physical examination of the patient will be carried out, including assessing reflexes, muscle strengths and any sensory abnormalities to assess neurological function.⁵
• Imaging tests:
  • Magnetic Resonance Imaging (MRI) – the standard test for diagnosing meningiomas because it can provide a detailed picture of the spinal cord and its surrounding structures, including the location and size of the tumour. However, MRI tests cannot help determine the tumour’s growth rate and, therefore, cannot be used as an early detection test for spinal meningiomas⁵
  • Computed Tomography (CT) scan – patients who cannot have an MRI performed will have a CT scan, which can show the bony structures of the spinal column, including any disturbance to the spinal canal caused by the tumour⁵ 
  • Myelogram – only done in some cases, as it involves injecting a contrast dye into the spinal canal, followed by an X-ray, to help visualise the spinal cord⁵
• Biopsy for definitive diagnosis – a small sample of the tumour tissue is taken and then examined by a specialist. However, this is only done when the diagnosis is uncertain or the tumour is suspected to have become malignant (cancerous)⁵

Treatment options for spinal meningiomas

• Monitoring and observation – initially, patients and their tumours are monitored with regular evaluations and imaging techniques. 
• Surgical intervention:
  • Types of surgery performed 
    • Endoscopic techniques - these methods are considered minimally invasive as they only make a small incision to remove the tumour⁵
    • Laminectomy - this type of surgery allows direct, easy access to the spinal canal and tumour whilst minimising damage to the spinal cord and its surrounding tissue, which allows the tumour to be directly targeted and removed.⁵
    • En Bloc Resection - only done when the tumour has not spread to any critical tissue. Here, the tumour and part of the material surrounding it  is removed as a whole to avoid the tumour spreading further to any more tissues⁵ 

• Risks and benefits of surgery 
  • The benefit of surgery generally is that it aims to remove the tumour completely, thereby preventing any growth or recurrence in the future, and can relieve neurological symptoms.
  • Surgery has the risk of damaging the spinal cord and/or nerves, involves the loss of blood during surgery, and the risk of infection.

• Radiation therapy – when surgical interventions are unsuccessful or not possible, radiation therapy is carried out by targeting radiation at the tumour. This helps to either shrink or kill the tumour cells, thereby reducing the size of the tumour ⁵
• Medication – can be given to help relieve pain, reduce inflammation and help to alleviate discomfort. However, this only helps the patient to live with the symptoms of spinal meningioma; it does not treat it ⁵
• Hormonal therapy – is very new and rarely used, but it has been shown to target oestrogen and progesterone hormones to help treat the symptoms.⁵
• Rehabilitation and supportive care – physical therapy is given to improve mobility and balance, psychological support, including counselling, is given to help cope with the emotional aspects of living with spinal meningiomas, and a combination of therapy and medication are all available for patients to help alleviate some of the pain⁵

Preparing for spinal meningioma treatment

• Consultation with healthcare professionals - will be exposed to a number of professionals, including oncologists, neurosurgeons and therapists, to support the patient through this journey. 
• Medical evaluations and tests - medical history, imaging/scans and biopsies to confirm diagnosis 
• Mental and emotional preparation - the patient is recommended to seek help and support from family, friends and professionals to help the patient’s journey through difficult times 
• Support system and resources - to find people/organisations that can provide support during the journey as well as help to educate the patient with all the information needed

Prognosis and follow up care

• Factors influencing prognosis (outcome of the medical condition) include features of the tumour (i.e., smaller tumours are less likely to reoccur), successful complete surgical removal of the tumour, and age/health of the patient⁶
• Long-term outlook and survival rates – survival rates for spinal meningiomas are high, with a mortality rate from 0 -1 %.⁴ However, follow-up care after treatment is an important factor in the patient's survival. This includes attending regular follow-up appointments to monitor the spinal cord, as well as to evaluate the success of the treatments and any complications that could have risen after treatments⁶

Summary

Spinal meningiomas are tumours that develop at the membrane that surrounds and protects the spinal cord. They are often non-cancerous and can be treated through surgery, radiation therapy, and medication. Due to the tumour’s location, it can damage the spinal cord and/or nerves, which results in symptoms such as weakness, numbness, loss of sensation, and pain. Therefore, it is important to diagnose spinal meningioma early, to allow early provision of the appropriate treatment, and follow up with close monitoring, support and care to ensure the tumour does not grow back.