Meningiomas — Timoteo Almeida, MD, PhD

Meningiomas

Common tumors arising from the meninges — the layers surrounding the brain. Many are simply observed, while others require treatment based on size, symptoms, growth, location, and tumor grade.

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Common brain tumor

Many meningiomas are found incidentally and never cause symptoms. Others require treatment based on growth, location, or grade.

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Radiosurgery is established

Gamma Knife SRS is a validated option — used as primary treatment, or after surgery for residual or recurrent tumor.

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Individualized decisions

Treatment pathways include observation, surgery, and radiosurgery — and many patients benefit from a combined approach.

Understanding your condition

What are meningiomas?

Meningiomas arise from the meninges — the protective layers surrounding the brain. They range from incidental findings that never cause symptoms to tumors that affect vision, neurologic function, or seizure risk depending on their location and size.

Treatment choices are individualized and guided by tumor grade, location, symptoms, and prior treatment history. In practice, management typically falls into three pathways — and many patients benefit from a combined approach.

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Observation

Periodic MRI surveillance for small, asymptomatic tumors without concerning features

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Surgery

Resection for tumors causing mass effect, symptoms, or when tissue diagnosis is needed

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Radiosurgery

Focused SRS for selected tumors — as primary treatment or for residual/recurrent disease

Many patients benefit from a combined approach — for example, surgery for decompression followed by SRS for residual tumor.

Am I a candidate?

Who may be a candidate for Gamma Knife radiosurgery?

Potential candidates include patients with:

Candidacy is determined by tumor characteristics and your clinical situation.

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    Smaller tumors that are appropriate for focused radiation rather than open surgery.
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    Tumors in surgically challenging locations — such as the skull base or near critical structures.
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    Residual tumor after surgery — when complete removal wasn't possible or safe.
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    Recurrent tumor — regrowth after previous surgery or treatment.
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    Patients who prefer a non-incisional approach when their tumor characteristics allow it.
Your options

Treatment Options

The right approach depends on your tumor's size, location, grade, symptoms, and treatment history. These options are often complementary rather than competing.

☢ Radiosurgery

Gamma Knife Radiosurgery

Stereotactic radiosurgery for selected meningiomas

How it works Highly focused radiation beams converge on the tumor with sub-millimeter precision. Evidence-based guidance supports SRS as a validated modality for selected benign intracranial meningiomas.
When used Primary treatment for appropriate tumors, adjuvant after surgery for residual disease, or salvage for recurrence.
Key advantage High likelihood of long-term tumor control with no incision and short recovery. Outpatient treatment.
No incision Outpatient High control rate
🔧 Surgical

Microsurgical Resection

Open surgery for decompression, diagnosis, or cure

When recommended Large tumors causing pressure on the brain or nerves (e.g., vision symptoms), significant swelling, or when tissue diagnosis is needed.
Goal When safe, surgery can remove most or all of the tumor and relieve symptoms by decompressing nearby structures. Gross total resection may be curative.
Combined approach Surgery is often followed by radiosurgery for residual tumor — particularly when complete removal would risk neurologic function.
Decompression Tissue diagnosis Potentially curative
👁 Surveillance

Observation

Watchful waiting with periodic imaging

When appropriate Small, incidental meningiomas without concerning features — especially if the tumor is not growing on serial imaging.
What it involves Careful surveillance with periodic MRI to monitor for growth. If the tumor begins to grow or causes symptoms, treatment can be reconsidered.
Key advantage Avoids any treatment-related risks when the tumor may never require intervention. Many meningiomas remain stable for years.
No treatment Serial MRI Low-risk tumors

Gamma Knife Immobilization Options

The best approach depends on lesion location, size, and treatment plan.

Frame-based

Rigid Head Frame

Single-session, high-precision delivery. The frame is placed under local anesthesia on the morning of treatment and removed the same day.

Mask-based (frameless)

Image-Guided Frameless

Comfortable mask immobilization with onboard imaging. Supports fractionated strategies when needed to protect nearby critical structures like cranial nerves.

Your journey

What to Expect

For patients undergoing Gamma Knife radiosurgery, the process is typically straightforward and outpatient.

Before

MRI planning, discussion of goals (tumor control, symptom prevention), and review of prior surgery or pathology if applicable. Your team will determine whether frame-based or mask-based immobilization is best for your case.

During

Outpatient radiosurgery session(s) with frame or mask immobilization. The treatment itself is painless — you rest while the Gamma Knife delivers precisely focused radiation to the tumor.

After

Follow-up imaging to monitor tumor response. Some tumors swell temporarily before stabilizing — your team will counsel on steroid use if needed. Long-term imaging confirms durable control.

Weighing your options

Benefits and Risks

Potential Benefits

  • ✦ High likelihood of long-term tumor control for selected meningiomas
  • ✦ No incision and short recovery — most resume routine activity quickly
  • ✦ Outpatient treatment — typically same-day
  • ✦ Can treat tumors in locations that are surgically challenging

Possible Risks

  • △ Fatigue, headache, temporary swelling around the treated area
  • △ Cranial nerve effects depending on tumor location (e.g., hearing, facial sensation, vision)
  • △ Rare delayed radiation injury
Common questions

Patient FAQs

Is SRS a "one-and-done" treatment?
Often yes — many meningiomas are treated in a single session. However, some cases use a fractionated plan (multiple sessions) based on tumor location and safety considerations, particularly when protecting nearby cranial nerves.
Do I still need surgery?
Some meningiomas are best treated with surgery — particularly large tumors causing pressure symptoms or when a tissue diagnosis is needed. SRS is often used for select tumors where surgery isn't needed, or for residual or recurrent disease after surgery.
Will my tumor disappear?
Many tumors stabilize in size after radiosurgery; some shrink gradually over months to years. The primary goal is durable tumor control — stopping growth and preventing symptoms — rather than complete disappearance.
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When to Seek Urgent Care

Seek urgent help for new seizures, sudden weakness, severe headache with vomiting, confusion, or new visual loss.

Why Dual-Specialty Expertise Matters

For patients choosing between implant-based neuromodulation and lesioning options, a physician trained in both functional neurosurgery and radiation oncology can help align the procedure choice with your goals, anatomy, and long-term plan.

Schedule a Consultation →