May 13th, 2011
02:00 PM ET

Gupta: Waiting out a meningioma

All the news about one of my favorite actresses, Mary Tyler Moore, reminded me of the first time I saw a patient with a meningioma. It was 1995. I was a junior neurosurgery resident, and my professor introduced me to a 69-year-old, perfectly healthy appearing woman. That surprised me at the time, because moments earlier, I had been reviewing her MRI scan. She had an obvious bright mass in her brain located in the right frontal lobe.

I carefully examined the movements of her eyes and face. I checked her motor strength and sensation in her four extremities and completed a full neurological exam. Her long-term memory and instant recall were intact, and she did not complain of headaches. “I wouldn’t even know it is up there,” she said, referring to her brain tumor.

This pleasant woman had been showing up at the clinic for several years, with a scan in hand to review with my professor. If the mass looked no different, and more importantly, if the patient didn’t have any neurological changes – they would simply make a date to see each other again in another year, and repeat the process. They had collectively agreed to not operate on the obvious brain tumor, but instead to watch, wait, and bank on the possibility she would never need an operation in her lifetime.

That may sound surprising, given we are talking about brain tumors. Truth is, while there are many types of brain tumors that do require urgent operations, meningiomas are often treated differently. They have such a characteristic appearance on an MRI scan, there is often little doubt when you see one. And, about nine out of 10 times, they are benign. If the tumor is relatively small, the patient is not very young, and there are no symptoms – the neurosurgeon is likely to offer the “watchful waiting” as an option.

Two years later, we did operate on the then-71-year-old woman. Her most recent scan had shown a sudden growth in the size of the mass. Worried that it might continue growing at an accelerating rate, my professor and the patient collectively agreed an operation was the best course of action.

There are other things that may have tipped the scale toward an operation. If the mass had changed in its appearance, and looked more malignant. And, of course, if our patient had started to have any symptoms such as blurriness of vision, seizures, headaches or weakness, to name a few.

These are the types of conversations and considerations Mary Tyler Moore has likely been having with her doctors over the past few years, now deciding an operation was prudent for possibly one of these reasons. By the time you read this, Ms. Moore may have already had the brain surgery necessary to remove the tumor, and may even be scheduled for radiation treatment, which is sometimes necessary if all the tumor cannot be removed. Here is wishing her a speedy recovery.

Each week, CNN’s Dr. Sanjay Gupta, also a practicing neurosurgeon, posts a “medical mystery” photo from inside his operating room on Twitter. Follow @SanjayGuptaCNN and tweet Dr. Gupta your best guess!

soundoff (1,497 Responses)
  1. Robin

    I was trying to say and misspelled ...I am Wishing the Best for Mary Tyler moore.....

    Thank you, Robin

    May 16, 2011 at 21:38 | Report abuse | Reply
    • teresa


      October 17, 2011 at 22:19 | Report abuse |
  2. Jody

    Strongly wishing Mary Tyler Moore well.

    I was dx'd with a spinal cord meningioma (way high in the neck, at C-1 - the first spinal cord vertebra). It was accidentally found on an MRI for painful signs of disk damage in lower neck disks.

    This was around the time of 9/11, and I thought some of my "minor" symptoms were just stress - slight numbness in part of my face; very slight stress incontinence; most notably, a couple of minor falls or trips crossing a street or going up stairs; a slight sense of foot drop in one foot. It all made sense after the MRI.

    I was also offered "watchful waiting," but the symptoms were real (though mild). I asked two candidate neurosurgeons: Would you want your spouse or sister operated on at this point, if they had "my" meningioma and subtle symptoms, at age 50? They both said "Yes." That was all I needed to hear.

    I asked one of the surgeons: "Am I likely to be able to ride my moped after the operation?" (This was a not-very-subtle probe, really meaning, "Do you think I'll be okay?") He deadpanned to my husband, big twinkle in his eye, "How much will you pay me to say she can't ride her moped any more?" I did continue to ride, after I recovered from the surgery!

    I think "watchful waiting" would have been for more stressful for me than "having it out." But clearly, this is an individual taste, and partly related to the already-present (but mild) symptoms. So I had it out.

    Apparently, "We got it all" (which is what my surgeon said) means there is about an 85% chance it won't come back. Except for the occasional foot drop when I am tired, all the other symptoms resolved. I don't obsess about the 15% chance of recurrence, and only get a followup MRI every few years, less often than the insurance company allows.

    It is amazing that such a terrifying diagnosis did not cause far more psychological upheaval than it did. I attribute this to the wonderful support of family, doctors, and the ability to do my own research on the internet, to validate what I was being told.

    My thoughts are with "MTM" and all others facing this scary - but not as bad as an astrocytoma or glioblastoma - diagnosis. Be a full partner with your doc and family; tell them what you want, what you fear, and what you want to know, every step of the way. Good luck, "MTM", and thank you so much for all the entertainment pleasure you have given to so many for such a long time.

    May 16, 2011 at 23:39 | Report abuse | Reply
  3. Bob

    Dr. Gupta:
    Is microsphere embolizationfor benign meningioma an option? Some work done in Germany many years ago. May offer an option that makes surgery easier or perhaps avoid surgery.


    May 16, 2011 at 23:43 | Report abuse | Reply
  4. Dano

    Not having definitive answers about Meningiomas in my opinion is a crime. An emotional, mental and phyisical crime on those who suffer from them. Dear media,..stop minimizing the affects of Meningiomas. Any brain tumor which requires vascular blood flow is "alive" and should NOT be in, on, or near the brain. Why is it Meningiomas are considered less threatening when it feeds off the human life source? It is similar to a parasite living off it's host. It is a foregin "mass" and deserves the full and ACCURATE attention from ALL media outlets and government funding for research. It is just as dangerous as any other type of brain tumor. Wishing MTM all the very best. Praying for a speedy and uneventful recovery.

    May 17, 2011 at 13:02 | Report abuse | Reply
    • Tuawana Williams

      Thanks for your post. I often feel like I have not anyone to turn to or who understands how I feel about this "watching and waiting". I've had one large menigioma removed completely in 2003, however it returned in 2011. It is very small now, and I had the radiation treatments in 2011 and have been watching with an MRI each year since that time. I continue to have weakness in my legs, annoying ear pain, and increasing confussion. Nevertheless, I'm simply told that everything looks the same on the MRI, and I should see an ENT. I know this tumor is affecting me but I simply don't know where to turn. Thanks again.

      September 26, 2014 at 18:39 | Report abuse |
  5. Billy

    I had a menigioma removed via craniotomy 5 months ago after 4 years of monitoring (after 3 years of inactivity, the tumor doubled in size in a short period of time and was headed for the ocular chiasm). I am truly blessed – it is as though nothing ever happened and I was back at work fewer than 2 months after the surgery with no side affects other than a wicked scar under my hairline.

    There is no overstating the fear that comes with the discovery of a brain tumor, and the issue strikes young and old alike (I was 27 when I was diagnosed). As much as I was told it was the "good" kind of brain tumor (and it was, no doubt about that), it doesn't change the fact that this is a life-altering and frightening experience. I wish MTM the best and know the prayers she will be receiving will help as they did with me.

    May 17, 2011 at 21:00 | Report abuse | Reply
    • Donna

      I was diagnosed with a meningioma in March of his year and had it removed April 4. I suffered a slight stroke during the surgery that weakened my left side. I did 2 weeks rehab therapy and now am back at home. Now I just need radiation treatmennts to remove the 15% that was unable to be removed. It's been an amnzing journey. I'm finding more and more people who have his. Within a week of discovering I had this diagnosis, I met 2 women who recently had theirs removed 6 months prior.

      May 15, 2012 at 12:22 | Report abuse |
  6. Steve

    On Easter Sunday of this year, just before daybreak, I was awoke by what sounded like my 17 year old son hyperventilating. I went to his bedroom to try and wake him up because I thought he was having a bad dream. He wouldn't wake up. To make a long story short, he was having a seizure. I did not know it at the time. He had never had one before, and he is the picture of health. The paramedics took him to the hospital where he was given a CT scan, X-ray and MRI. They found a cavernous hemangioma. I don't know the difference between that and a meningioma, but don't think either are good. My son has been told by the neurologists at the Cleveland Clinic that he must have this removed because it has bled significantly. He is scared, as you can imagine, as am I and his mother. Such a good kid. I want to thank every one that had the courage to deal with your situation and I pray for you all and would ask that you also pray for my son, Anthony. He is such a good, respectful young man, and I can't bear the thought of anything bad happening to him. All he wants to do is drive a car, which we were going to do shortly, but in Ohio, you cannot drive for 6 months once you have seizure. But that is really the least of our worries right now. Thanks again and God bless you all!

    May 19, 2011 at 22:38 | Report abuse | Reply
  7. george atkins


    July 20, 2011 at 08:06 | Report abuse | Reply
  8. Mia

    Dear Dr. Gupta,
    I was saddened to read about MTM meningioma back in May. The news read that she was having a "routine" operation. I, too, had a craniotomy to remove a meningioma a little over a year ago. Although understand from the medical professional perspective, this operation is routine. From the patience perspective it is anything but. It has been life altering but not necessarily in a bad way. Although I still suffer from headaches and fatigue, it has given me the courage to take risk and make changes in my life. I consider myself one of the lucky ones. So routine for some is life altering for others.

    July 21, 2011 at 18:40 | Report abuse | Reply
  9. teresa


    October 17, 2011 at 22:19 | Report abuse | Reply
  10. Lily Lara

    I have a right frontal meningioma the size of a marble. I am 50 years old and suddenly started having seizures and weakness in the left side and double vision on my right eye. I have been to several doctors and one has diagnosed me with PNES which means I am having "pseudo" seizures. My husband tells me I am getting them while I sleep. Could this meningioma be causing these seizures? I am not on any anti-seizure medication. I would appreciate any input.

    October 30, 2012 at 15:56 | Report abuse | Reply
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    January 31, 2013 at 05:08 | Report abuse | Reply
  12. Alona Combest

    Brain surgery may be carried out due to various varying reasons. The most notable reason why brain surgery procedure is carried out is due to the growth of tumors in the brain. Brain tumor leads to complications such as memory loss and in most cases death. Though brain tumor is operable there are some tumors that are literally inoperable due to their extensive growth. Other than brain surgery, removal of tumors from the brain can be done through chemotherapy. This is however recommended for cancer patients. Other reasons that can facilitate brain surgery include brain hemorrhage and severe head injuries. :

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    February 11, 2013 at 09:02 | Report abuse | Reply
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  14. Ladonna Cutty

    Patients with intraparenchymal bleeds have symptoms that correspond to the functions controlled by the area of the brain that is damaged by the bleed...'^

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    June 10, 2013 at 01:53 | Report abuse | Reply
  15. JHrncir

    Can exposure to ionizing radiation result in the development of a meningioma tumor? If so, can this tumor possibly start a growth period let's say for 30 years prior to its detection? What are some of the employment areas that would be high risk for this type of tumor to develop other than medical fields?

    September 16, 2013 at 03:10 | Report abuse | Reply
  16. Gerry P.

    I got into an car accident and was unconscious . The doctors x-rayed and MRI me to death...they
    saw that I have a Meningioma on the back of my head, on the layers protecting the brain and sitting on all the nerves.
    I am 72. One doctor wants to take it out. I went for second opinion and this doctor wants to keep an eye on it. The tumor
    is 1.6cc and has been there awhile as I was told. I really don't know what to do. The set backs are just as bad to be
    operated than not to be operated........I am so scared and confused.......The tumor is the size of a cherry.

    December 20, 2014 at 15:26 | Report abuse | Reply
  17. Gerry P.

    I am a woman of 72. I got into a car accident and was unconscious, flown to hospital where they took x-rays and
    MRI, this is when they discovered the Meningioma I have on the outer layers that protect the brain. It is sitting on
    all the nerves at the back of the head and neck. I have not experienced anything unusual. The tumor is not big, the
    size of a cherry 1.6cc. One doctor wants to remove it, second opinion doctor wants to keep a watch on it. I have read
    so many things that I am scared. Can someone please help......

    December 20, 2014 at 15:47 | Report abuse | Reply
    • Brenda Merriweather

      If it is not causing you problems Just keep a eye on it these are most likely slow growing and at your age you may be able to live out your life with it, im 55 and I have one the size of a tennis ball so I'm having it removed as it gives me headaches.

      April 18, 2015 at 14:09 | Report abuse |
  18. anna

    I have had a meningioma removed 6 months ago Eyes still hurt but doctor says it is strain....... I am always scared and thinking whats next...

    July 24, 2015 at 07:50 | Report abuse | Reply
  19. anna

    Hi Sorry Anna here again. I wanted to say I am so tired of feeling so afraid of whats next.. I keep looking for things that might appear on my boy and in my body. Can someone help calm me down with some knowledge please

    July 24, 2015 at 07:52 | Report abuse | Reply
  20. anna

    Has anyone responded?

    September 15, 2015 at 22:59 | Report abuse | Reply
  21. Barbara

    A few months ago two meningiomas were found near my eyes. The vision in my right eye is almost all gone. I'm very afraid of surgery. If I wait and watch, I'll have my sight that much longer. If I have surgery now, there could be bad consequences. I'm a 76 year old woman with afib. I'm afraid of the after effects of anesthesia. Operation would take 5-7 hours. I live alone. I don't know what to do. I would be very grateful for your advice.

    October 12, 2016 at 08:29 | Report abuse | Reply
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  23. AL Muhab Abdul

    Admin please help share my story! My wife was diagnosed with inoperable Brain tumor in august of 2015 which was measuring about 12cm X 9cm X 9cm in her frontal lobe the tumor had probably been there for years and took up around 68% of her brain pushing through her sinus cavity as well. This was like a hell of a news for me because she just delivered our 7 months old son and i was deeply terrified as to what her fate will be because the doctor said her case was very severe and she needed urgent attention because she had just about less than 6 months before the cancer take her away from me. To summarize it all i was able to get a permanent cure for her after all the several modern treatments and therapies and save her from the cold hands of death and cancer from Dr. Joseph who treats cancer with pure natural herbs and extracts with his herbal medicine called elixir. All my life i have never seen any usefulness of herbal medicine not up till this moment that it saved my wife. I had to wait two years to write this so i can be really convinced she is permanently cured, up till now she is still very much healthy. I am overly grateful. If you have brain tumor, brain cancer, and any other forms of brain diseases do not hesitate to contact Dr. Joseph on
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    February 27, 2017 at 17:01 | Report abuse | Reply
  24. kenshigley

    My bride has been fighting meningioma for nearly 29 years - four surgeries, multiple rounds of radiation, three years of chemo (mostly Avastin), disabled from teaching 23 years ago, now rapidly progressing disability on all fronts. Since August she has needed a fulltime caregiver, and has rapidly deteriorated from full mobility to leaning on my arm, to a four-point cane, to a walker, and now a transport wheelchair whenever she leaves home. Her field of vision is now a narrow slit, and reading much of anything is impossible. Hearing has deteriorated severely. Balance is so poor that she at risk to fall any time she stands without support. Facial palsy has progressed in the past year so that the right side of her face severely sags. The tumor has resumed growing despite radiation and chemo. After 29 years, we are clearly in the worst 1% of meningiomas.

    April 7, 2017 at 11:58 | Report abuse | Reply
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  26. Denise

    I was diagnosed with a meningioma tgat was attached to my left optic nerve in Feb of 2002. In March of 2002 I went to UMASS to have a wonderful neuro sugeon perform the complicated surgery. The carotid artery and pituitary were involved. The surgeon removed most but not all of the tumor because of the artery. I lost the vision in my left eye. I had radiation at MD Anderson in Orlando who had just installed the laterst machines so the dose could be formed to the shape of the tumor and minimized (hopefully!) radiation on good cells. I have been having MRIs every year and now skipping to every two years.
    My radiation oncologists has moved. Any suggestions on what kind od Doctor to use for follow up? I have just been using my Internist and basically the radiological reading. Suggestions? Thank you.

    January 7, 2018 at 20:44 | Report abuse | Reply
  27. Shelby4087@aol.com

    Just diagnosed with incidental small meningioma in right frontal lobe. As a professional psychologist, my scientific curiosity outweighs my anxiety (I think!) I am almost 85 and at my age, watch and wait is the most reasonable treatment.

    July 22, 2018 at 09:51 | Report abuse | Reply
  28. Mary

    I have a small right frontal convexiry meningioma that had not grown since it was diagnosed 20 years ago...until now. Because of the recent growth, treatment is recommended. I have consulted with two neurosurgeons. One doctor recommended a craniotomy. The other recommended cyber surgery. From what I understand through my research, a craniotomy and complete removal of the tumor is most often recommended. Thanks in advance for any information and/or suggestions that could guide me in making the best treatment choice.

    February 20, 2019 at 23:16 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.