When a Parent Suddenly 'Changes Personality': A 6 cm Meningioma Had Been Growing in His Skull for Three Years

Dr. Zhang Xuejun at a patient's bedside at Shanghai Donglei Brain Hospital.

When "Getting Old" Is Actually a Tumor's Distress Signal

Shanghai, September 29 — When an elderly person suddenly "undergoes a personality change," walks unsteadily, or develops urinary incontinence, family members should pay close attention: these may not be simple signs of "aging." Dr. Zhang Xuejun, a neurosurgery specialist in Shanghai, told China News Service reporters on September 29 that such symptoms — especially when they appear in combination — are very likely the brain's "distress signals."

He stressed that if an elderly family member shows the above signs, children and relatives must stay alert and promptly bring them to a neurosurgeon for a head CT or MRI scan. He shared one case: Mr. Wang (pseudonym), 66, once a talkative man, gradually fell silent and withdrawn. His sense of smell and taste declined, he began to wet himself, and his walk became unsteady. His family assumed these were simply signs of aging — until he suddenly developed high fever with chills and intermittent headaches, and was rushed to the hospital. The examination results stunned the whole family: buried at the base of his skull was a giant meningioma over 6 centimeters in diameter. This tumor, larger than a ping-pong ball, had been growing silently and compressing his brain for three years.

A Map of the Brain's "Alarm Signals"

Dr. Zhang Xuejun explained that Mr. Wang's chain of symptoms was precisely the result of the tumor pressing on different brain regions:

• Frontal lobe compression — emotional apathy, personality change, and urinary incontinence;
• Parietal lobe involvement — impaired taste and abnormal body sensation;
• Mass effect of the huge tumor volume — headaches and limb weakness, eventually leaving him bedridden.

A Few-Centimeter Corridor Instead of a Large Craniotomy

Facing a tumor that was both deep-seated and huge, the expert team held a dedicated case discussion and chose the lateral supraorbital minimally invasive approach. Compared with conventional craniotomy, this operation requires only a few-centimeter incision and no large-scale removal of the bone flap. It minimizes the stretching of brain tissue by surgical instruments, protects the olfactory nerve function to the greatest extent, and significantly reduces the risk of postoperative complications such as cerebrospinal fluid leakage. After hours of meticulous microsurgery, the team successfully completely dissected and removed the tumor. Shortly after surgery, Mr. Wang was able to converse clearly again, the incontinence and other symptoms that had troubled him disappeared, and his recovery progressed smoothly.

Understanding Meningioma: The Brain's Most Common "Uninvited Guest"

Dr. Zhang Xuejun explained that a meningioma originates from the meninges — the membranes that wrap the brain — rather than from brain cells themselves, so the overwhelming majority (about 90%) are benign tumors. They usually grow slowly with clear boundaries, and their main harm lies in physical compression: as they enlarge, they squeeze the surrounding brain tissue, nerves, or vessels. That is why Mr. Wang's meningioma was able to grow silently for years.

Meningiomas vary greatly in size. Small tumors (1–2 cm in diameter) are often symptom-free and are usually discovered incidentally during health checkups; medium-sized ones (3–5 cm) may cause headaches and mild neurological symptoms; while large or giant meningiomas of 6 cm or more in diameter can very easily cause significant neurological impairment — headache, declining vision, limb weakness, sensory abnormalities, epilepsy, cognitive and personality changes, and more. He added that the condition is most common in people over 40, especially middle-aged women, and incidence rises with age. People with a history of head radiation exposure or neurofibromatosis type 2 are also at higher risk.

Not Every Meningioma Needs "One Cut Fits All"

What should be done once a meningioma is found? Dr. Zhang Xuejun emphasized that not all meningiomas require surgery. Treatment should follow an individualized, stepwise "customized plan" that comprehensively considers the tumor's size, location, growth rate, and symptoms, as well as the patient's age and overall health:

• Tumors ≤ 2 cm with no symptoms, especially in elderly or physically frail patients — the first-choice strategy is regular observation, with no immediate surgery or radiotherapy;
• Obvious symptoms, tumors of 3–5 cm, or continued growth on follow-up — surgical resection is the first choice and may be curative;
• Giant tumors like Mr. Wang's must be operated on.

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