Meningioma grew 2mm and now they're offering Gamma Knife OR surgery and asking ME to choose. How do they normally decide?

Bit of background. 23mm meningioma, found by accident 18 months ago when I had a scan for vertigo that turned out to be my ears. No symptoms from it at all. We've been watching it, scan every nine months, and the first follow-up was "no change" which I'd made my peace with.

Third scan came back last week: grown 2mm. Which I know is tiny, it's two grains of rice, but apparently it's enough that "continue watching" is no longer the only option on the table. I saw the consultant on Thursday and the summary was: the tumour board reviewed it, BOTH Gamma Knife and an operation are reasonable for this one, have a think about which you'd prefer and come back.

Have a think?? I spent six months of my life choosing a kitchen worktop. I am not qualified to choose brain treatment. My husband thinks it's a good sign that they're relaxed enough to offer both. I think if the experts can't pick one, how on earth can I? What actually makes them recommend one over the other, and did anyone else get handed the steering wheel like this?

I got the same steering wheel for my meningioma, so I can at least tell you how it looked from this side. Mine was 19mm, no pressure symptoms, and the surgeon was very straight with me: at that size and position both routes work, if it had been 4cm we would not be having this conversation, you'd be having surgery.

What settled it for me was asking each specialist what I'd be trading. Surgery meant it's physically gone, but a head operation, a hospital stay and weeks of recovery. Gamma Knife meant one day, no cutting, back feeding the birds by the weekend, but the tumour STAYS THERE on the scans. That last part is the thing to get your head around, I honestly thought the radiation would dissolve it. It doesn't. Mine is still visible on every scan, same lump, it just stopped growing, and my team count that as success.

I chose the Gamma Knife and I'd choose it again, but I know a chap from my support group who picked surgery for a similar one because he couldn't stand the idea of it still being in there. Neither of us is wrong. It came down to which trade we could live with.

Same experience with my acoustic neuroma, different tumour but the identical "both are reasonable, what do you think" conversation. I asked my surgeon flat out "what would you have" and he wouldn't bite, but he did say something useful: when we offer you the choice it's because the outcomes are close enough that YOUR priorities are the tiebreaker. Fear of an operation, fear of leaving it in, work, recovery time, that stuff is real data to them, not you being difficult.

Your husband has it right. The scary version is when they don't offer a choice.

Diane, the direct answer to "how do they decide" is that four things drive the recommendation: size, symptoms, position, and how certain we are of the diagnosis. Radiosurgery is generally the stronger option for meningiomas of about 3 to 3.5cm or smaller that are not pressing on anything, which is why, at 23mm and symptom-free, you sit squarely in territory where both treatments perform well. Surgery moves to the front when the tumour is large, is causing pressure symptoms that need relieving quickly, or when the scans look unusual enough that a pathologist needs actual tissue to confirm what it is. A typical-looking meningioma on MRI is confidently treated without a biopsy, which is why nobody is insisting on an operation for yours.

On what radiosurgery achieves: for a benign, grade I meningioma the published five-year control rates run roughly 85 to 100%, most studies landing around the mid-90s, using a margin dose in the 12 to 16 Gy range. Paul has described the catch honestly: control means it stops growing, not that it vanishes, and the result is confirmed over years of follow-up MRI rather than declared on the day. Position matters too; a tumour sitting very close to the optic nerves changes the dose arithmetic and can push a team towards operating or towards splitting the treatment into several sessions. The site's guide to Gamma Knife for meningioma sets out those numbers, and when surgery or continued observation genuinely is the better answer.

Being asked to choose is not the team shrugging. It means the board looked at your scans and found genuine equipoise, and at that point your own priorities are the correct deciding factor. Take a written list of questions back to them, including "is continuing to watch still on the table", and let them apply the answers to your actual images, which is something no forum can do.

No meningioma here (AVM) but I was also handed a choice and I remember the fury. It felt like being abandoned by the people who were supposed to know. A year on I see it differently: it was the one part of the whole business I got any say in. Write the list Mr Halloran suggests. Mine had eleven questions on it and nobody rushed me.

Update for anyone who finds this in the same boat. Went back with fourteen questions (beat you, Susan). Watching was still an option but neither of us loved it now it's shown it can grow. Asked both specialists to talk me through THEIR half honestly, and what swung it in the end was recovery: I look after my mother three days a week and the operation meant weeks I don't have.

Gamma Knife booked for the end of June. I still think it's absurd that the kitchen worktop took longer, but it turns out the worktop never had a tumour board checking its measurements. Thank you all, genuinely.