Meningioma

Diagnosis, monitoring, and surgical treatment of meningiomas in Lahore, Pakistan

Found a Meningioma on Your MRI? What It Means

A meningioma is a tumor that arises from the meninges — the three protective layers of tissue that surround the brain and spinal cord. Meningiomas are the most common type of primary brain tumor in adults, and the large majority are benign, slow-growing, and highly treatable. Being told you have "a mass" or "a tumor" on a brain scan is understandably frightening, but for most patients a meningioma diagnosis is far less alarming than it first sounds.

Because meningiomas grow slowly, a great many are discovered incidentally — found by chance when a person has a brain scan for an unrelated reason, such as a headache work-up, a minor head injury, or dizziness. Others come to attention because of symptoms caused by the tumor's size or, more often, its specific location — for example, pressing on a particular part of the brain, a cranial nerve, or the spinal cord.

The single most important question after a meningioma is found is not simply "is it big or small" but "what grade is it, where exactly is it, and is it changing over time." Those three factors — grade, location, and growth on serial scans — drive almost every decision about monitoring versus surgery.

Dr. Waqas Mehdi, FCPS Neurosurgeon at MidCity Hospital Lahore, evaluates newly diagnosed meningiomas, explains what the MRI findings actually mean in plain language, advises on whether monitoring or surgery is appropriate, and performs microsurgical removal for those requiring treatment.

Symptoms of a Meningioma

!Headaches, often gradually worsening
!Seizures
!Vision changes or double vision
!Weakness in an arm or leg
!Loss of smell (for tumors near the frontal skull base)
!Hearing loss or facial numbness (for skull base tumors)
!Personality or memory changes
!Many meningiomas cause no symptoms and are found incidentally

Symptoms vary enormously depending on exactly where the tumor sits, which is why two people with a similarly sized meningioma can have completely different complaints. A meningioma at the front of the brain (frontal lobe) may cause a slow, subtle change in personality, judgement, or memory rather than a headache — something families often notice long before the patient does. A meningioma pressing on the optic nerve or the visual pathway can cause gradual, painless vision loss that is easy to attribute to "getting older" or needing new glasses. A meningioma near the ear (cerebellopontine angle) may present with hearing loss or facial numbness rather than any of the more "classic" brain tumor symptoms. This is one of the main reasons meningiomas are sometimes missed for months or years before diagnosis.

Meningioma Grades Explained — Grade I, II, and III

The World Health Organization (WHO) classifies meningiomas into three grades based on how the tumor cells look under the microscope after biopsy or surgical removal. This grade — far more than the tumor's size — is the single biggest factor determining long-term outlook, recurrence risk, and whether any treatment is needed after surgery.

Grade I — Benign

The vast majority of meningiomas, roughly 80-85%, fall into this category. These are slow-growing, benign tumors with a low recurrence rate after complete surgical removal. Many are simply monitored for years without ever needing an operation.

Grade II — Atypical

Makes up most of the remainder, around 15-18% of cases. Atypical meningiomas grow somewhat faster, have a higher chance of recurring even after surgery, and are more likely to need closer MRI follow-up or, in some cases, radiotherapy after removal.

Grade III — Malignant/Anaplastic

Rare, accounting for roughly 1-3% of meningiomas. These are aggressive tumors that can grow quickly and recur or, uncommonly, spread within the central nervous system. They typically require surgery combined with radiotherapy and closer, longer-term follow-up.

The grade can only be confirmed by examining tumor tissue under the microscope after biopsy or surgery — MRI alone can suggest a higher-grade tumor (based on features like irregular borders or surrounding brain swelling) but cannot definitively grade it. This is one reason surgical removal, when it is needed, is valuable for both treatment and diagnosis.

Meningioma Location and Why It Matters (Convexity, Skull Base, Parasagittal)

Where a meningioma is located affects both the symptoms it produces and how complex and risky its surgical removal is. Location is often discussed with as much weight as grade when planning treatment.

Convexity Meningiomas

Located on the outer surface of the brain, just under the skull, away from major blood vessels and nerves. These are generally the most straightforward to access and remove, with a lower risk of surgical complications compared to deeper locations.

Skull Base Meningiomas

Located at the base of the skull, close to critical structures such as the cranial nerves (controlling vision, eye movement, facial sensation, and hearing), the carotid artery, and the brainstem. These require meticulous microsurgical or endoscopic technique, and surgery is more complex with a correspondingly higher — though carefully managed — risk profile.

Parasagittal and Falcine Meningiomas

Located along or near the superior sagittal sinus, the major vein draining blood from the brain, or the falx (the membrane dividing the two brain hemispheres). Surgery here needs added care to avoid injury to the venous sinus, since damage can cause dangerous brain swelling or stroke-like complications.

Spinal Meningiomas

Meningiomas can also arise from the meninges lining the spinal canal rather than the brain, typically causing back pain, limb weakness, or numbness. These are managed as a related but distinct condition — see our page on spinal cord tumors for more detail. Read more about spinal cord tumors →

Diagnosis

MRI Brain with Contrast: The key diagnostic test — meningiomas have a very characteristic appearance on contrast MRI, including the classic "dural tail" sign, which helps distinguish them from other tumor types and gives clues about location and likely behaviour.
CT Scan: Useful for assessing whether the tumor has caused any bone changes (hyperostosis) or calcification, and for surgical planning near the skull, especially for skull base tumors.
Serial Imaging (for monitored tumors): Repeat MRI at defined intervals — commonly 6 to 12 months initially, then longer if stable — to track growth rate in small, asymptomatic meningiomas being managed conservatively.
Formal Vision and Neurological Testing: For tumors near the optic nerves or other cranial nerves, baseline formal visual field or hearing assessment helps detect subtle changes over time that may not be obvious to the patient.

Does Every Meningioma Need Surgery?

This is the question almost every newly diagnosed patient asks, and the honest answer is: no. The decision to operate weighs the tumor's grade (where known or suspected), its location, whether it is causing symptoms, and whether it is growing on serial scans — not simply the fact that a tumor exists.

Observation (Watch and Scan)

The preferred approach for small, asymptomatic meningiomas found incidentally, especially in older patients or those with tumors in surgically difficult locations. Repeat MRI at 6-12 month intervals tracks any growth; many such tumors never require intervention at all.

Microsurgical Removal

The primary treatment for symptomatic or growing meningiomas. Performed under the operating microscope, aiming for complete removal of the tumor and its attachment to the meninges, which offers the best chance of a permanent cure and also provides tissue for accurate WHO grading.

Endoscopic / Minimally Invasive Approaches

For select skull-base meningiomas, keyhole or endonasal endoscopic approaches can reduce brain retraction and speed recovery compared to traditional open craniotomy.

Stereotactic Radiosurgery

An option for small meningiomas in high-risk locations, residual tumor after surgery, atypical (Grade II) tumors with incomplete removal, or patients unfit for surgery — delivers focused radiation while sparing surrounding brain tissue.

Radiotherapy After Surgery

Considered for atypical (Grade II) or malignant (Grade III) meningiomas, particularly when removal was incomplete, to reduce the risk of recurrence.

What Happens If a Meningioma Is Left Untreated?

For many small, low-grade, asymptomatic meningiomas, "leaving it alone" under proper surveillance is a legitimate and safe long-term strategy — not neglect. However, an untreated meningioma that is growing can gradually compress surrounding brain tissue, nerves, or blood vessels, leading to progressively worsening headaches, seizures, vision loss, weakness, or cognitive change that may become permanent if allowed to continue for too long. This is why "observation" always means active, scheduled monitoring with imaging — not simply ignoring the diagnosis. If a tumor shows growth, develops new symptoms, or is found to be a higher grade, the balance shifts toward treatment before complications become irreversible.

Frequently Asked Questions

What is a meningioma?
A meningioma is a tumor arising from the meninges — the layers of tissue that cover and protect the brain and spinal cord. The vast majority (roughly 85-90%) of meningiomas are benign (WHO Grade I), growing slowly over years.
Who treats meningiomas in Lahore?
Dr. Waqas Mehdi, FCPS Neurosurgeon and Assistant Professor at KEMU/Mayo Hospital, Lahore, manages meningiomas from initial diagnosis and monitoring through to microsurgical or endoscopic removal when indicated.
Do I need surgery for a small meningioma found incidentally?
Not necessarily. A large proportion of meningiomas are picked up incidentally on a scan done for an unrelated reason, and many of these are small, asymptomatic, and very slow-growing. In such cases, careful observation with periodic MRI is often a perfectly reasonable and safe approach — surgery is reserved for tumors that are symptomatic, enlarging, or in a location where future growth would be risky.
How fast do meningiomas grow?
Growth rate varies widely. Most Grade I meningiomas grow very slowly, sometimes only a millimetre or two per year, which is why many are simply monitored rather than operated on immediately. Atypical (Grade II) tumors tend to grow faster and are more likely to show measurable change between scans, which is one of the reasons grading matters for planning follow-up.
Can a meningioma turn cancerous?
A benign Grade I meningioma does not suddenly transform into a malignant Grade III tumor in the way some people fear. However, a small number of meningiomas are atypical (Grade II) from the outset, and on rare occasions a tumor can recur at a higher grade than the original, which is why regular follow-up imaging after surgery remains important, especially for Grade II tumors.
Does every meningioma need surgery?
No. Many small, asymptomatic meningiomas found incidentally on a scan can simply be monitored with periodic MRI, since they often grow very slowly or not at all. Surgery is considered when the tumor is causing symptoms, is growing on serial scans, or is in a high-risk location.
Is a meningioma cancer?
Most meningiomas are benign, not cancerous, and do not spread to other parts of the body. A small proportion are atypical (Grade II) or malignant (Grade III) and may need additional treatment such as radiotherapy after surgery.
What is the recovery time after meningioma surgery?
Recovery depends heavily on the tumor's size, location, and the surgical approach used. Straightforward convexity meningiomas often allow patients to return to light activity within two to four weeks, while tumors near the skull base or major venous sinuses may need a longer, more gradual recovery with closer early follow-up.
Can a meningioma come back after surgery?
Recurrence is possible even after apparently complete removal, and the risk depends mainly on the tumor's grade and how completely it was resected. Grade I meningiomas that are fully removed have a relatively low recurrence rate, while Grade II and Grade III tumors carry a meaningfully higher risk, which is why long-term MRI follow-up is recommended for everyone, not just those with residual tumor.
Is a meningioma hereditary?
Most meningiomas occur sporadically, without any family history. A minority are linked to genetic conditions such as neurofibromatosis type 2 (NF2), which can cause multiple meningiomas, or to prior radiation exposure to the head. If several close relatives have had meningiomas, this is worth mentioning to your neurosurgeon.

Newly Diagnosed with a Meningioma?

Consult Dr. Waqas Mehdi for a clear, individualised explanation of your MRI and the right next steps — whether that means monitoring or surgery. MidCity Hospital, Lahore — Mon to Sat, 6–8 PM.

Call: 0300-8482624Book Appointment

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