Meningioma is a predominantly nonmalignant tumor of the meninges occurring at both cranial and spinal sites.
Meningiomas cause symptoms from local mass effect due to compression of neural structures or may present with seizure. Increasingly, they are identified while asymptomatic when imaging the neuro-axis for unrelated reasons.
Diagnosis should be confirmed by the characteristic appearance on magnetic resonance imaging (MRI) with and without contrast enhancement.
Asymptomatic lesions may be followed up with serial observation.
Treatment of symptomatic meningioma is usually surgical resection, although in some cases, local radiation therapy is used as primary treatment. Surgery provides pathologic diagnosis, which is increasingly important, as the meningioma grade may impact radiation doses and follow-up surveillance paradigms.
Radiation therapy is given as adjuvant treatment for World Health Organization grade 3 meningiomas. Adjuvant radiation is also considered in some cases of subtotally resected grade 1 and many grade 2 lesions.
Meningiomas are the most common primary tumor of the cranial and spinal compartments. Estimates indicate that they represent 39.7% of all primary central nervous system tumors, and 55.4% of all nonmalignant tumors. They are more frequent in women. Nearly 20% of tumors are found to be atypical, classified as World Health Organization (WHO) grade 2, and are more likely to recur and cause morbidity after primary treatment. Malignant WHO grade 3 tumors are rare.
History and exam
Key diagnostic factors
- family history of brain tumor
Other diagnostic factors
- neurologic deficit
- family history of NF2
- history of breast cancer
- history of radiation
- radiation therapy
- genetic predisposition
- hormones: endogenous and exogenous
- head trauma
1st investigations to order
- MRI brain or spine with and without contrast
- CT head or spine
Investigations to consider
- histopathology of surgical resection
- somatostatin receptor positron emission tomography (PET)
good surgical candidate
poor surgical candidate
recurrent tumor following surgical resection
- Dural metastasis
- IgG4-related disease
- NCCN guidelines: central nervous system cancers
- EANO guidelines for the diagnosis and management of meningiomas
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