Can you request surgery?

@lsme1999: I can understand why you've come to Mayo Clinic Connect to inquire about this, and I welcome you here. It can be very concerning - alarming even - to be told you have a meningioma, which is often described as a tumor over a layer of the brain. These are quite different from the more aggressive types of brain tumors that are malignant.

This explains more about meningiomas: https://www.mayoclinic.org/diseases-conditions/meningioma/diagnosis-treatment/drc-20355648
It does specify that a small meningioma such as yours doesn't require treatment if it is not causing symptoms. In many cases, these meningiomas remain stable, or even shrink.

It is generally not advisable to perform intervention as that could potentially carry more risks than a small meningioma itself. In other words, the risks of performing such treatment could outweigh the benefits of leaving it alone if it's completely asymptomatic - as it appears to be in your case. Should you experience the symptoms you described or if imaging should show significant growth, treatment such as radiation - or Gamma Knife - or surgical resection could then be considered. Your medical provider could provide more detail about these treatments if you're interested in learning about them should the need for intervention arise.

Does this information help explain why an individual with a small meningioma would most likely not be considered as medically necessary for surgery or radiation?

I would get a second opinion.

@as72

I definitely agree about getting the second opinion. If both experts agree about the lack of need to immediately do something, but agree on the necessary monitoring, one can relax a little. But if they don’t agree, there may be choices to be made.

Unless the small meningioma is considered medically necessary insurance will not pay. But you can go to a plastic surgeon who I’m certain would help you in a cash bases. If it’s small enough to done in the office you can get off cheap. If it’s something that will require anesthesia administered it will cost you big bucks.

@jenatsky: I’m wondering if perhaps you’re thinking of a similar sounding condition, a hemangioma. It can be confusing as medical terminology may sound alike but can be quite different in presentation and treatment.

A hemangioma is a collection of blood vessels that are often referred to as a “strawberry mark”, and you’re correct that some plastic surgeons can treat these in office.

A meningioma, on the other hand, is a generally benign (Grade 1) tumor like growth arising from the meninges of the spinal cord or brain that doesn’t cause symptoms. Individuals who have these are advised to monitor with regular imaging scans or immediately report if they become symptomatic at which time intervention would be indicated. This is a decision made by a neurologist or neurosurgeon who may perform a craniotomy (removal of a portion of the skull to gain access to the brain) or a specialized radiation procedure.

What I had initially attempted to answer is an individual cannot request either intervention (surgery or radiation) in cases like this as it is not considered an elective procedure. The above guidelines serve as the general basis for medically necessary treatment for meningiomas.

Does that help to explain the difference?

You’re correct I did confuse the two. Thanks for the clarification.

@lsme1999: I'd meant to provide this link from Mayo that explains more about meningiomas: https://www.mayoclinic.org/diseases-conditions/meningioma/symptoms-causes/syc-20355643

My initial response was more along the lines about one's ability to request surgery on their own, without a medical provider indicating it was medically necessary. That would likely result in an insurance denial and most proviers would not perform such intervention(s). However, if you remain symptomatic and have not been satisfied with the response from the provider you had consulted, seeking the recommendation of another specialist may very well be beneficial. To best prepare for such a visit, some providers would like to see a record of symptoms, such as a headache diary (keeping track of daily details about headache frequency, intensity, duration, and associated symptoms) to better understand your presentation and plan for any indicated next steps.