Meningioma treatment focuses on controlling tumor growth, relieving symptoms, and improving quality of life. Most of these slow-growing tumors can be managed effectively through surgery, radiation therapy, or careful monitoring, depending on their size, location, and how quickly they grow.

How Doctors Approach Meningioma Care Today

When someone learns they have a meningioma, the path forward depends on many personal factors. The treatment plan is built around the specific characteristics of the tumor itself, including how large it has grown, where exactly it sits in the brain or spinal cord, and which of the three tumor grades it falls into. A person’s age, overall health, and personal preferences also shape the decisions made by the medical team.^[1]

Medical societies around the world have developed guidelines to help doctors choose the best approach for each patient. These recommendations are based on years of research and experience treating thousands of people with meningiomas. The goal is always to reduce symptoms caused by the tumor pressing on brain tissue, stop the tumor from growing larger, and help people return to their normal activities whenever possible.^[8]

Because most meningiomas grow very slowly—sometimes only about one millimeter per year for the most common type—not every person needs immediate treatment. Some people live for many years with a small meningioma that causes no problems at all. In these cases, doctors may recommend regular check-ups with brain scans rather than jumping straight to surgery or radiation.^[2]

For those who do need active treatment, the good news is that meningiomas respond well to current therapies. About eight out of ten cases can be cured, particularly when the tumor is caught early and can be completely removed.^[6] At the same time, researchers are working hard to develop new medicines and techniques that may offer even better results in the future, especially for tumors that are harder to treat.

Standard Treatment Methods

Surgery

Surgery remains the most common and effective treatment for meningiomas that cause symptoms or continue to grow. The operation is called a craniotomy, which means the surgeon creates an opening in the skull to reach the tumor. The goal is to remove as much of the tumor as possible without damaging nearby brain tissue, nerves, or blood vessels.^[8]

The success of surgery depends greatly on where the tumor is located. Meningiomas growing on the outer surface of the brain, called convexity meningiomas, are usually easier to remove completely because they are more accessible. However, tumors at the base of the skull or wrapped around critical blood vessels and nerves present a much greater challenge. In these difficult locations, surgeons may only be able to remove part of the tumor to avoid causing serious complications like vision loss, paralysis, or problems with speech and swallowing.^[3]

Complete removal—when the surgeon can take out the entire tumor and even some of the surrounding tissue where it was attached—offers the best chance that the tumor won’t come back. For Grade 1 meningiomas that are completely removed, the chance of recurrence is quite low. However, Grade 2 and Grade 3 tumors are more aggressive and have a higher chance of returning even after surgery.^[4]

After surgery, most people stay in the hospital for several days. Recovery time varies, but many people can return to their normal activities within a few weeks to a few months. The surgical team will watch closely for any complications, which can include bleeding, infection, seizures, or swelling in the brain. Some people may need physical therapy, occupational therapy, or speech therapy afterward to regain abilities affected by the tumor or the surgery itself.^[9]

Observation and Watchful Waiting

Not every meningioma needs immediate treatment. Many are discovered by accident when someone has a brain scan for another reason, like after a head injury or while investigating unrelated headaches. If the tumor is small, not causing any symptoms, and growing very slowly, doctors often recommend a “wait-and-see” approach.^[7]

This strategy involves regular monitoring with MRI scans (magnetic resonance imaging), typically performed every six to twelve months at first, and then less frequently if the tumor remains stable. The doctor will also ask about any new symptoms at each visit. If the tumor starts to grow faster or begins causing problems, treatment can be started at that time.^[8]

Watchful waiting is especially common for elderly patients or those with other serious health conditions that make surgery risky. It’s also used for very slow-growing Grade 1 meningiomas that are discovered early, before they become large enough to press on important brain structures.^[19]

Radiation Therapy

Radiation therapy uses high-energy beams to damage tumor cells and stop them from growing. It’s an important option for people who cannot have surgery because of their age, other health problems, or because the tumor is in a location that makes surgery too dangerous. It’s also used after surgery when some tumor was left behind or when a tumor comes back after previous treatment.^[8]

There are two main types of radiation used for meningiomas. Stereotactic radiosurgery delivers a very precise, high dose of radiation to the tumor in one or just a few sessions. Despite the name “surgery,” no incision is made—the patient simply lies still while the machine delivers radiation from multiple angles, all focused on the tumor. This technique is very effective for small to medium-sized meningiomas and causes minimal damage to surrounding healthy brain tissue.^[13]

The other approach is fractionated radiation therapy, where smaller doses of radiation are given over several weeks. Each daily treatment takes only a few minutes. This method allows healthy tissue more time to recover between treatments while still affecting the tumor cells.^[8]

Side effects from radiation can include fatigue, hair loss in the treated area, scalp irritation, and headaches. Most of these effects are temporary and improve after treatment ends. Some people may experience long-term effects like changes in memory or thinking, especially if large areas of the brain are exposed to radiation, though modern techniques have greatly reduced these risks.^[5]

Medications

Currently, there are no medications that can cure meningiomas or make them shrink. However, medicines play an important supporting role in managing symptoms caused by the tumor. Anti-seizure drugs, also called anti-epileptic medications, are prescribed for people who have had seizures caused by their meningioma. These medicines help prevent future seizures and allow people to continue their daily activities more safely.^[6]

Corticosteroids, such as dexamethasone, are powerful anti-inflammatory drugs used to reduce brain swelling around the tumor. When a meningioma grows large enough, it can cause swelling in the surrounding brain tissue, leading to headaches, nausea, and other symptoms. Steroids can provide quick relief from these problems, though they are usually used for short periods because long-term use can cause significant side effects like weight gain, high blood sugar, mood changes, and weakened bones.^[5]

Pain relievers may be prescribed for headaches, and other medications can help with specific symptoms depending on which part of the brain is affected by the tumor.

Treatment Being Tested in Clinical Trials

While surgery and radiation work well for many meningiomas, researchers are actively searching for new treatments that could help people whose tumors are harder to control. This is especially important for Grade 2 and Grade 3 meningiomas, which grow more aggressively and are more likely to return after treatment. Clinical trials are testing several promising approaches.^[11]

Targeted Therapy

Scientists have discovered that meningiomas grow and spread through specific molecular pathways—chains of signals that tell cells when to divide and multiply. Targeted therapies are drugs designed to block these specific signals. Unlike chemotherapy, which affects all rapidly dividing cells in the body, targeted therapies aim to stop only cancer cells while leaving healthy cells alone.^[11]

One important area of research focuses on drugs that block growth factor receptors on the surface of tumor cells. For example, some meningiomas have high levels of a receptor called VEGF (vascular endothelial growth factor), which helps tumors grow new blood vessels to feed themselves. Drugs that block VEGF, called angiogenesis inhibitors, are being tested to see if they can slow meningioma growth by cutting off the tumor’s blood supply. Bevacizumab is one such drug being studied in clinical trials.^[11]

Another promising target is the PI3K/AKT/mTOR pathway, a series of proteins inside cells that control growth and survival. Some meningiomas have mutations that make this pathway overactive. Drugs called mTOR inhibitors, such as everolimus, are being tested to see if blocking this pathway can slow tumor growth or shrink tumors.^[11]

These targeted therapies are typically tested in Phase I and Phase II clinical trials. Phase I trials focus on safety—determining the right dose and watching for side effects. Phase II trials look at whether the treatment actually works by measuring whether tumors shrink or stop growing. Early results from some of these trials have shown that a small number of patients experience tumor shrinkage or stabilization, though more research is needed to understand which patients benefit most.^[11]

Hormone-Based Therapies

Many meningiomas have receptors for hormones, particularly progesterone, on their cell surfaces. In fact, up to 72% of meningiomas express progesterone receptors. This has led researchers to wonder whether hormone-blocking drugs might help slow tumor growth.^[5]

Several clinical trials have tested drugs that block hormone receptors or reduce hormone levels in the body. One example is mifepristone, a drug that blocks progesterone receptors. While early studies showed some promise, larger trials have had mixed results, with most showing that the drugs do not significantly shrink meningiomas. However, researchers continue to study whether certain subtypes of meningiomas might respond better to this approach, and whether combining hormone therapy with other treatments might improve results.^[11]

Immunotherapy

Immunotherapy is a type of treatment that helps the body’s own immune system recognize and attack cancer cells. The immune system normally protects us from infections and diseases, but cancer cells often hide from immune detection. Immunotherapy drugs are designed to unmask cancer cells so that immune cells can destroy them.^[11]

One type of immunotherapy being studied for meningiomas is immune checkpoint inhibitors. These drugs block proteins that act like brakes on the immune system, allowing immune cells to attack tumors more vigorously. Drugs like pembrolizumab and nivolumab, which target a checkpoint protein called PD-1, are being tested in early-phase clinical trials for aggressive meningiomas that have come back after other treatments.^[11]

Another experimental approach involves vaccine therapy, where researchers try to “train” the immune system to recognize specific proteins found on meningioma cells. These vaccines are still in very early stages of testing, but they represent an exciting potential future direction.

Where Clinical Trials Are Happening

Clinical trials for meningioma treatments are taking place in major medical centers across the United States, Europe, and other parts of the world. In the United States, the National Cancer Institute and large academic hospitals often lead these studies. Many trials are also conducted through international collaborations, allowing researchers to study larger groups of patients.^[12]

To participate in a clinical trial, patients usually need to meet specific criteria. These requirements, called eligibility criteria, might include the grade and type of meningioma, whether previous treatments have been tried, the patient’s age and overall health, and whether the tumor has grown or spread. People interested in clinical trials should talk with their medical team to learn about studies they might qualify for.^[12]

Ongoing Research Into Better Treatments

Beyond specific drugs, researchers are also studying better ways to deliver existing treatments. For example, some studies are testing whether combining targeted therapy with radiation therapy could be more effective than either treatment alone. Others are exploring new surgical techniques that use advanced imaging and robotics to remove tumors more completely and safely.^[10]

Scientists are also working to better understand the biology of meningiomas at the molecular level. By identifying which genetic mutations and molecular changes drive tumor growth, they hope to develop more personalized treatment approaches where each person receives therapy tailored to the specific characteristics of their tumor.^[11]

Most Common Treatment Methods

• Surgical Removal
  • Craniotomy is performed to access and remove the tumor through an opening in the skull
  • Complete removal offers the best chance of cure for Grade 1 meningiomas
  • Partial removal may be necessary when tumors are located near critical brain structures
  • Minimally invasive techniques are used when possible to reduce recovery time
• Radiation Therapy
  • Stereotactic radiosurgery delivers precise, high-dose radiation in one or few sessions for small to medium tumors
  • Fractionated radiation gives smaller doses over several weeks for larger tumors
  • Used when surgery is too risky or when tumor remains after surgery
  • Effective for controlling tumor growth with minimal damage to healthy tissue
• Observation and Monitoring
  • Regular MRI scans every six to twelve months to track tumor size and growth
  • Appropriate for small, slow-growing tumors that cause no symptoms
  • Particularly suitable for elderly patients or those with other health conditions
  • Treatment begins only if tumor grows or causes symptoms
• Medication for Symptom Management
  • Anti-seizure drugs prevent and control seizures caused by the tumor
  • Corticosteroids like dexamethasone reduce brain swelling and relieve pressure symptoms
  • Pain relievers help manage headaches
  • Medications tailored to specific symptoms based on tumor location
• Targeted Therapy (Experimental)
  • Drugs that block growth factor receptors like VEGF to cut off tumor blood supply
  • mTOR inhibitors such as everolimus to block cellular growth pathways
  • Tested in Phase I and Phase II clinical trials for aggressive meningiomas
  • Aim to slow growth or shrink tumors with fewer side effects than traditional chemotherapy
• Immunotherapy (Experimental)
  • Immune checkpoint inhibitors like pembrolizumab and nivolumab help immune system attack tumor cells
  • Vaccine therapies train immune system to recognize meningioma proteins
  • Being tested in early-phase trials for recurrent, aggressive meningiomas
  • Represents a promising future direction for difficult-to-treat tumors