Meningioma

I think it is important to be straightforward. Although I am a spinal surgeon, primary tumours of the coverings of the spinal cord are a specialised field that I do not take on. I believe this surgery should be carried out by colleagues who do a high volume of it, because their experience translates into safer removal and better protection of the spinal cord. So when a meningioma is found, my role is to identify it, ensure the correct scans are done, and refer you without delay to an expert in spinal tumour surgery. What follows is written to help you understand the condition.

Because a meningioma grows slowly and presses on the cord gradually, symptoms usually develop over months and can be subtle at first. Common features include back pain, sometimes worse at night, followed by numbness or altered sensation, weakness or heaviness in the legs, problems with balance and walking, and, as compression advances, bladder or bowel symptoms. The pattern depends on where along the spine the tumour lies. Because the symptoms build up gradually, they are sometimes attributed to more common problems at first, which is one reason prompt, accurate assessment matters.

The key investigation is an MRI scan with contrast, which shows the tumour, its exact position relative to the cord, and features that suggest it is a meningioma. This imaging is essential both for diagnosis and for the specialist surgeon to plan a safe removal. My part is to ensure this imaging is arranged and interpreted correctly, so that you reach the right specialist promptly and with the right information.

The mainstay of treatment for a symptomatic or enlarging spinal meningioma is careful microsurgical removal by a spinal tumour specialist, using an operating microscope and, where appropriate, nerve monitoring to protect the cord. Because most spinal meningiomas are benign and well-defined, complete removal — including the small area of attachment — often gives an excellent and durable result, and the published evidence shows good neurological recovery and low recurrence when surgery is carried out by experienced, high-volume surgeons, even in older patients. The completeness of removal is described using the Simpson grading system, which the specialist will consider. Where surgery is needed, it belongs in expert hands, which is why I refer these cases on.

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