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PubMed This is a summary of 92 peer-reviewed journal articles Updated
Neurology

Understanding Meningioma: The Basics and Biology

At a Glance

Meningiomas are typically slow-growing, benign tumors that arise from the protective layers of the brain and spinal cord, not the brain tissue itself. Risk factors include female gender, prior radiation, and certain high-dose hormone medications.

A meningioma diagnosis can feel overwhelming, but understanding the biology behind it can help replace fear with clarity. These tumors are most often slow-growing and are not “brain cancer” in the traditional sense because they do not start in the brain tissue itself [1]. Instead, they arise from the meninges, the protective layers of tissue that wrap around the brain and spinal cord [2]. Specifically, they grow from arachnoid cap cells, which are specialized cells within the middle layer of these membranes [1].

Who Typically Gets Meningiomas?

Meningiomas are the most common type of primary tumor found in the central nervous system [3]. While they can affect anyone, research shows clear patterns in who is most likely to be diagnosed:

  • Gender and Age: They are significantly more common in women than in men [3]. Risk also tends to increase as people get older [4].
  • Race: Studies indicate higher incidence rates among African-American individuals compared to other groups [3][5].
  • Socioeconomic Factors: Some research suggests that meningiomas are more frequently diagnosed in individuals with higher household incomes or those living in urban areas, which may be related to better access to high-quality medical imaging [6][7].

Understanding the Risk Factors

While most meningiomas happen without a clear cause, science has identified several key factors that may increase risk:

Hormones and Medications

The link between hormones and meningiomas is a major area of study.

  • Progestogens: Long-term use of certain high-dose progestogens (synthetic versions of the hormone progesterone) is linked to an increased risk [8][9]. This includes medications like cyproterone acetate, medrogestone, and medroxyprogesterone acetate [10][11]. Interestingly, some common forms of birth control, like levonorgestrel intrauterine systems (IUDs), have not shown this increased risk [12].

    Important Patient Safety Warning: Do not panic-stop your birth control or hormone replacement therapy (HRT). Abruptly stopping hormones can pose immediate health risks. Instead, bring a list of all your current hormonal medications to your doctor to discuss whether safe alternatives are needed.

  • Breast Cancer: There is a recognized connection between a history of breast cancer and the development of meningiomas [13]. This may be due to shared biological pathways involving estrogen receptors or DNA repair mechanisms [13][14].

Other Major Risks

  • Ionizing Radiation: Exposure to high doses of radiation (often from prior radiation therapy to the head) is a well-established risk factor [15][14].
  • Genetic Factors: Conditions like Neurofibromatosis Type 2 (NF2) can predispose individuals to develop multiple meningiomas [16].

Identifying “Mimics” on Imaging

On a standard MRI (Magnetic Resonance Imaging), most meningiomas have a classic appearance, often showing a “dural tail”—a thickening of the nearby membrane that looks like a small tail [17]. However, other conditions can look very similar on a scan, which is why doctors look closely at the details.

Mimic Condition Key Differences
SFT/HPC (Solitary Fibrous Tumor) These tend to be more aggressive and may show bone erosion or “feeding vessels” on a scan [18][19].
Dural Metastases These occur when cancer from another part of the body (like the lungs or breast) spreads to the meninges [17].
Dural Chondrosarcoma A rare tumor of the cartilage that can occasionally appear in the same location [20].

How Doctors Tell the Difference

To distinguish a meningioma from a mimic, specialists may use advanced imaging techniques:

  • DWI (Diffusion-Weighted Imaging): Measures how water molecules move through the tumor to help identify its density [21].
  • MRS (MR Spectroscopy): A “virtual biopsy” that looks at the chemical makeup of the tumor. For instance, high levels of myo-inositol can point toward an SFT/HPC rather than a meningioma [22].
  • Radiomics: Using AI and deep learning to analyze thousands of features in an MRI that the human eye cannot see, helping to predict the tumor’s type and grade before surgery [23][24].

While the word “tumor” is frightening, remember that the vast majority of meningiomas are Grade 1 (benign) and many can be managed with simple monitoring or highly effective, targeted treatments [25][26].

Explore the Guide

01

Symptoms, Locations, and The Decision to Treat

Learn how meningioma location affects symptoms like headaches and seizures. Understand peritumoral edema and when to choose watch-and-wait versus surgery.

02

Decoding Your Pathology Report: The 2021 WHO Grading System

Learn how to read your meningioma pathology report using the 2021 WHO grading system. Understand tumor grades, molecular markers, and mitotic count meanings.

03

Surgery, Radiation, and the Path to Control

Understand your meningioma treatment options. Learn about brain surgery, the Simpson Scale, recovery times, and targeted radiation therapies like SRS.

04

High-Grade and Recurrent Meningiomas: Emerging Therapies

Learn about treatment options for high-grade and recurrent meningioma. Understand systemic therapies, PRRT, molecular profiling, and emerging clinical trials.

05

Survivorship: Life with Long-Term Surveillance

Learn about life after meningioma treatment. Understand long-term MRI surveillance schedules, managing scanxiety, seizure control, and cognitive health.

Common questions in this guide

Is a meningioma a type of brain cancer?
Meningiomas are not traditional brain cancer because they do not start in the brain tissue. Instead, they grow from the meninges, which are the protective layers surrounding the brain and spinal cord. Most are slow-growing and non-cancerous.
Do hormonal medications or birth control cause meningiomas?
Long-term use of certain high-dose progestogens has been linked to an increased risk of developing meningiomas. However, you should never abruptly stop hormone replacement therapy or birth control without consulting your doctor to discuss safe alternatives.
What does a dural tail mean on my MRI report?
A dural tail is a thickening of the membrane near a tumor that looks like a small tail on an MRI scan. This is a classic visual feature that helps doctors identify a meningioma rather than another type of mass.
How do doctors know for sure if my tumor is a meningioma?
Doctors use standard MRIs to look for features like a dural tail, but they may also use advanced imaging like MR Spectroscopy or Diffusion-Weighted Imaging. These tools analyze the tumor's density and chemical makeup to distinguish meningiomas from other tumors.
Is watchful waiting a safe option for a meningioma?
Yes, because the vast majority of meningiomas are Grade 1 and slow-growing, watchful waiting is often a safe and effective approach. Your doctor will help decide if monitoring the tumor with regular MRIs is appropriate based on its size and your symptoms.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my imaging, what features make this look like a meningioma rather than an SFT/HPC or a dural metastasis?
  2. 2.Does my MRI show a 'dural tail,' and how does that influence your diagnosis?
  3. 3.How does my history of [breast cancer/progestogen use] affect the management or expected behavior of this tumor?
  4. 4.Do you recommend advanced imaging, like MRS or DWI, to confirm the diagnosis before deciding on a treatment plan?
  5. 5.Given my age and the tumor's size, is 'watchful waiting' a safe option for me right now?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (26)
  1. 1

    Meningioma originating from the oculomotor nerve without dural attachment in a child.

    Wang Y, Liu Y, Sun P, et al.

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2023; (39(2)):553-556 doi:10.1007/s00381-022-05553-0.

    PMID: 35861856
  2. 2

    A rare case of intra-parenchymal meningioma in a female patient who presented with seizures: A case report.

    Duvuru S, Sanker V, Jain S, et al.

    Clinical case reports 2023; (11(9)):e7927 doi:10.1002/ccr3.7927.

    PMID: 37736479
  3. 3

    Nonmalignant and malignant meningioma incidence and survival in the elderly, 2005-2015, using the Central Brain Tumor Registry of the United States.

    Achey RL, Gittleman H, Schroer J, et al.

    Neuro-oncology 2019; (21(3)):380-391 doi:10.1093/neuonc/noy162.

    PMID: 30295804
  4. 4

    Elderly Patients with Intracranial Meningioma: Surgical Considerations in 228 Patients with a Comprehensive Analysis of the Literature.

    Ekşi MŞ, Canbolat Ç, Akbaş A, et al.

    World neurosurgery 2019; (132()):e350-e365 doi:10.1016/j.wneu.2019.08.150.

    PMID: 31476477
  5. 5

    The joint impacts of sex and race/ethnicity on incidence of grade 1 versus grades 2-3 meningioma across the lifespan.

    Walsh KM, Price M, Neff C, et al.

    Neuro-oncology advances 2023; (5(Suppl 1)):i5-i12 doi:10.1093/noajnl/vdad020.

    PMID: 37287573
  6. 6

    Racial or Ethnic Disparities in Incidence, Treatment, and Prognosis of Adult Intracranial Meningiomas.

    Li C, Yuan Q, Zhang Z, et al.

    Journal of racial and ethnic health disparities 2025; doi:10.1007/s40615-025-02650-z.

    PMID: 41082040
  7. 7

    Determinants of geographic variation in the incidence of adult nonmalignant meningioma in the United States, 2010-2019.

    Withrow DR, Boyle J, Linet MS, et al.

    Cancer 2025; (131(18)):e70042 doi:10.1002/cncr.70042.

    PMID: 40931922
  8. 8

    Progestogen use and the risk of intracranial meningioma: a systematic review and meta-analysis.

    Hudelist B, Roux A, Huet-Mignaton E, et al.

    EClinicalMedicine 2026; (92()):103791 doi:10.1016/j.eclinm.2026.103791.

    PMID: 41732194
  9. 9

    Surgical treatment of feline intracranial meningiomas: a retrospective study of 26 cases.

    Porsmoguer C, Blondel M, Moissonnier PHM

    Journal of veterinary science 2024; (25(2)):e25 doi:10.4142/jvs.23207.

    PMID: 38568826
  10. 10

    Use of progestogens and the risk of intracranial meningioma: national case-control study.

    Roland N, Neumann A, Hoisnard L, et al.

    BMJ (Clinical research ed.) 2024; (384()):e078078 doi:10.1136/bmj-2023-078078.

    PMID: 38537944
  11. 11

    Meningioma in users of progestogen contraceptives: a disproportionality analysis of the FDA Adverse Event Reporting System (FAERS).

    Woods RH

    European journal of clinical pharmacology 2025; (81(11)):1659-1668 doi:10.1007/s00228-025-03900-z.

    PMID: 40824302
  12. 12

    Oral contraceptives with progestogens desogestrel or levonorgestrel and risk of intracranial meningioma: national case-control study.

    Roland N, Kolla E, Baricault B, et al.

    BMJ (Clinical research ed.) 2025; (389()):e083981 doi:10.1136/bmj-2024-083981.

    PMID: 40500141
  13. 13

    Exploring the genetic correlation and causal relationships between breast cancer and meningioma using bidirectional Mendelian randomization.

    Ding L, Chen B, Zhou Z, et al.

    Scientific reports 2025; (15(1)):4271 doi:10.1038/s41598-025-88829-0.

    PMID: 39905226
  14. 14

    Presentation and management of spinal meningioma and its association with breast carcinoma-case series and systematic review.

    Wang D, Sadek AR, Vaseeharan S, et al.

    British journal of neurosurgery 2024; (38(6)):1460-1465 doi:10.1080/02688697.2022.2061419.

    PMID: 35435093
  15. 15

    Subsequent Meningiomas Among Survivors of Childhood Cancer.

    Bowers DC, Cooney T, Chen Y, et al.

    JAMA network open 2025; (8(12)):e2548715 doi:10.1001/jamanetworkopen.2025.48715.

    PMID: 41379444
  16. 16

    Lifestyle and metabolic factors affect risk for meningioma in women: a prospective population-based study (The Cohort of Norway).

    Gheorghiu A, Brunborg C, Johannesen TB, et al.

    Frontiers in oncology 2024; (14()):1428142 doi:10.3389/fonc.2024.1428142.

    PMID: 39188673
  17. 17

    Dural-based lesions: is it a meningioma?

    Nagai Yamaki V, de Souza Godoy LF, Alencar Bandeira G, et al.

    Neuroradiology 2021; (63(8)):1215-1225 doi:10.1007/s00234-021-02632-y.

    PMID: 33459822
  18. 18

    Are bone erosion and peripheral feeding vessels hallmarks of intracranial solitary fibrous tumor/hemangiopericytoma?

    Sugiyama H, Tsutsumi S, Hashizume A, et al.

    Radiology case reports 2022; (17(8)):2702-2707 doi:10.1016/j.radcr.2022.04.050.

    PMID: 35669225
  19. 19

    Grade III solitary fibrous tumor/hemangiopericytoma: An enthralling intracranial tumor-A case report and literature review.

    Al Armashi AR, Alkrekshi A, Al Zubaidi A, et al.

    Radiology case reports 2022; (17(10)):3792-3796 doi:10.1016/j.radcr.2022.07.007.

    PMID: 35965927
  20. 20

    Distinguishing Falcine Chondrosarcomas from Their Mimics and Management.

    Omezine S, Bouali S, Taallah M, et al.

    World neurosurgery 2018; (118()):279-283 doi:10.1016/j.wneu.2018.06.164.

    PMID: 30257291
  21. 21

    Differentiating intracranial solitary fibrous tumor/hemangiopericytoma from meningioma using diffusion-weighted imaging and susceptibility-weighted imaging.

    Chen T, Jiang B, Zheng Y, et al.

    Neuroradiology 2020; (62(2)):175-184 doi:10.1007/s00234-019-02307-9.

    PMID: 31673748
  22. 22

    Clinical and Radiographic Features for Differentiating Solitary Fibrous Tumor/Hemangiopericytoma From Meningioma.

    Ohba S, Murayama K, Nishiyama Y, et al.

    World neurosurgery 2019; (130()):e383-e392 doi:10.1016/j.wneu.2019.06.094.

    PMID: 31233926
  23. 23

    A Radiomics Model for the Differentiation of Intracranial Solitary Fibrous Tumor/Hemangiopericytoma and Meningioma Based on Multiparametric Magnetic Resonance Imaging.

    Xiong H, Yin P, Luo W, et al.

    Neurology India 2024; (72(4)):779-783 doi:10.4103/neurol-india.NI_213_20.

    PMID: 39216033
  24. 24

    A novel rotation and scale-invariant deep learning framework leveraging conical transformers for precise differentiation between meningioma and solitary fibrous tumor.

    Azam MT, Balaha HM, Mistry A, et al.

    Journal of pathology informatics 2025; (17()):100422 doi:10.1016/j.jpi.2025.100422.

    PMID: 40104410
  25. 25

    Management of intracranial meningioma: Outcome analysis and clinico radiological profile of 172 patients.

    Varshney A, Jaiswal S, Bajaj A, et al.

    Surgical neurology international 2024; (15()):464 doi:10.25259/SNI_556_2024.

    PMID: 39777178
  26. 26

    Stereotactic Radiosurgery for Intracranial Noncavernous Sinus Benign Meningioma: International Stereotactic Radiosurgery Society Systematic Review, Meta-Analysis and Practice Guideline.

    Marchetti M, Sahgal A, De Salles AAF, et al.

    Neurosurgery 2020; (87(5)):879-890 doi:10.1093/neuros/nyaa169.

    PMID: 32463867

This page explains the biology and risk factors of meningioma for educational purposes only. Always consult your neurologist or oncologist to discuss your specific diagnosis, symptoms, and appropriate management plan.

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