Feline Meningioma: Clinical Signs and Treatment Options

Feline Meningioma: Clinical Signs and Treatment Options

By: Austin Kerns, DVM, MS, DACVIM (Neurology) and Beryl Swanson, DVM, DACVIM (Neurology)

• Most common brain tumor in cats, typically 10 years or older
• Symptoms: altered mentation, circling and difficulty walking, blindness, and seizures
• MRI is needed to confirm the diagnosis and location of the tumor
• Surgery is the treatment of choice for accessible tumors
• In > 90 % of cats who undergo surgery, clinical signs resolve, and they tolerate surgery and anesthesia well – only ~10% have regrowth of their tumor in their lifetime
• Radiation therapy can eliminate/minimize symptoms for up to approximately 2 years

Meningioma is the most common brain tumor in cats. They are slowly growing tumors – the vast majority are considered “benign” but cause clinical problems because they grow within the skull and compress the brain. Malignant (anaplastic) meningiomas in the cat are rarely recognized. Most feline meningiomas grow in the front part of the brain (forebrain). Cats tend to be older at the time of their diagnosis (12-13 years). The clinical signs of the tumor are variable and depend on where the tumor is growing; behavioral changes are common – altered mentation, circling, ataxia, blindness, pacing and loss of balance are common clinical signs. Seizures may be the only clinical sign3.

A diagnosis is made based on advanced imaging (i.e., MRI). Once a diagnosis is made, then a discussion of treatment options is appropriate. In general, treatment options include medical management (e.g., drug/chemotherapy), radiation therapy and surgery. Chemotherapeutic options (drugs used to kill the tumor cells) are limited for brain tumors –their efficacy in the brain is poor because the blood vessels in the brain serve as a barrier to the entry of those drugs. The mainstay of medical management is oral steroids, which are used to reduce edema (swelling) that surrounds the tumor – this functionally reduces the mass effect of the brain tumor. This is a palliative treatment that may improve clinical signs in the short term but does not change the size or growth of the tumor itself.

Radiation therapy (RT) can be used in the treatment of brain tumors, including meningioma, that are not surgically accessible. A recent study evaluated the response to RT in cats that had brain tumors - the median overall survival time was 515 days for all tumor types combined4. Longer survival times were seen in cats with meningioma compared to cats with other types of tumors (eg, glioma).

For cats with surgically accessible meningioma, surgical excision has been shown to offer the longest survivals, and in many cases is essentially curative. A recent study examined survival times in cats who underwent surgery for meningioma. One hundred and twenty-one cats were included in this study5. The study showed low mortality of only 6% (cats who died during or immediately after surgery). During the course of the study, 6 cats were eventually euthanized due to confirmed regrowth of the tumor, with an additional 3 suspected to have re-growth based on a recurrence of clinical signs. Thus, only 16 out of 121 cats died as a direct consequence of the surgery or tumor regrowth. Cats that lived for more than 1 month after surgery had a median survival of over 3 years (38 months), with some surviving more than 4.5 years. Importantly, most of these long-term survivors (45/54) did not die from tumor regrowth; many cats in fact went on to die of age-related causes that were unrelated to the tumor. Additionally, although the median age of the cats in this study was 12 years, the survival times still exceeded 3 years, thus age does not prohibit recommendation of surgery for treatment of meningiomas in cats.

For cats with clinical signs that are compatible with a potential meningioma, or for cats with a confirmed meningioma, consultation with a neurologist should be strongly considered. If surgery is possible, then the clinical outcomes are usually quite good. In the majority of cases, perioperative complications are low, the survival times are long, and the quality of life after surgery is high. And while surgical excision may represent the most definitive treatment for feline meningioma, if surgery is not possible, it should be remembered that with appropriate medical management, we can often achieve temporary resolution of clinical signs that allows the cat and the owner to have good quality time together, which can be very comforting to an owner suddenly faced with a pet with neurological disease.

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Sources:

1. Tomek A, Cizinauskas S, Doherr M, et al: Intracranial neoplasia in 61 cats: localization, tumour types and seizure patterns. J Feline Med Surg. 2006;8:243–253.
2. Lu D, Pocknell A, Lamb CR, et al: Concurrent benign and malignant multiple meningiomas in a cat: clinical, MRI and pathological findings. Vet Rec 2003;152:780–782).
3. Troxel MT, Vite CH, Van Winkle TJ, et al: Feline intracranial neoplasia: retrospective review of 160 cases (1985–2001). J Vet Intern Med. 2003;17:850–859).
4. Körner M. et al: Radiation therapy for intracranial tumours in cats with neurological signs. J Feline Med Surg. 2018; 21(8), 765-771.
5. Cameron S et al: Characteristics and Survival of 121 Cats Undergoing Excision of Intracranial Meningiomas (1994-2011). Vet Surg. 2015 44(6):772-6.