Meningioma: when surgery is recommended

Learning that you have a meningioma can feel unsettling, and it is natural to have questions about what it means and whether surgery is necessary.

In this guide, consultant neurosurgeon Mr Sanjeeva Jeyaretna explains what a meningioma is, when surgery is recommended, and how decisions are made to ensure the best possible outcomes.

What is a meningioma?

A meningioma is a usually slow-growing tumour that develops from the meninges, the protective membranes surrounding the brain and spinal cord. Most meningiomas are benign (non-cancerous), and many are found incidentally during scans performed for other reasons. Because of this, not all meningiomas need immediate treatment.

When is surgery for a meningioma recommended?

Surgery is commonly recommended if a meningioma is causing symptoms. These may include headaches, seizures, changes in vision, weakness in an arm or leg, or difficulties with speech or memory. Symptoms often arise because the tumour is pressing on nearby brain tissue or nerves.

Evidence of tumour growth

If regular MRI scans show that a meningioma is increasing in size, surgery may be advised, even if symptoms are mild or not yet present. Growth suggests the tumour may cause problems in the future, and operating earlier can sometimes reduce surgical risk.

Tumour location and risk

The location of the meningioma is crucial. Tumours close to important structures such as the optic nerves, brainstem, or major blood vessels may require surgery sooner to prevent permanent damage. Conversely, meningiomas in less critical areas can often be monitored safely.

Suspicion of a higher-grade meningioma

While most meningiomas are benign, a small proportion are atypical or malignant. If scans suggest a higher-grade tumour, surgery is usually recommended to remove as much of it as possible and to confirm the diagnosis.

What does meningioma surgery involve?

The aim of surgery is to remove the tumour safely while protecting normal brain function. Advances in imaging, microsurgical techniques, and neuro-navigation have made surgery safer and more precise than ever. Recovery time varies depending on the tumour’s size and location, but many patients return to normal activities within weeks.

When surgery may not be necessary

Many meningiomas are small and cause no symptoms. In these cases, a “watch and wait” approach with regular MRI scans is often the best option. Some meningiomas never grow or cause problems.

Patient health and preferences

A patient’s age, general health, and personal wishes are always considered. If surgery carries higher risk due to other medical conditions, alternative options such as monitoring or radiotherapy may be more appropriate.

Surgery for a meningioma is recommended when the benefits clearly outweigh the risks, particularly in the presence of symptoms, tumour growth, or higher-grade features. Each case is individual, and decisions are best made through careful discussion between the patient and an experienced neurosurgical team.