Management of atypical and malignant (WHO grade II and III) meningioma
- Helen A Shih, MD
Helen A Shih, MD
- Associate Professor of Radiation Oncology
- Harvard Medical School
- Attending Radiation Oncologist
- Massachusetts General Hospital
- John K Park, MD, PhD
John K Park, MD, PhD
- Santa Barbara Neuroscience Institute
- Section Editors
- Jay S Loeffler, MD
Jay S Loeffler, MD
- Section Editor — Neurooncology
- Professor of Radiation Oncology
- Harvard Medical School
- Patrick Y Wen, MD
Patrick Y Wen, MD
- Section Editor — Neurooncology
- Professor of Neurology
- Harvard Medical School
Meningiomas account for approximately one-third of primary central nervous system tumors (table 1 and figure 1). Most meningiomas are benign (WHO grade I), although up to one-fifth of such tumors are classified as atypical (World Health Organization [WHO] grade II) or malignant (WHO grade III). (See "Epidemiology, pathology, clinical features, and diagnosis of meningioma", section on 'Pathology'.)
The management of patients with meningioma requires a balance between definitive treatment of the tumor and avoidance of neurologic damage from the treatment. Patient-specific factors (eg, presence or absence of symptoms, age, comorbidity), the location of the meningioma in relation to critical brain structures and regions, and the histopathologic characteristics (WHO grade) of the meningioma all are important factors in determining the optimal treatment.
The management of WHO grade II and grade III meningiomas will be reviewed here. Other topics on meningioma include:
●Epidemiology, pathology, clinical features, and diagnosis of meningioma (see "Epidemiology, pathology, clinical features, and diagnosis of meningioma")
●Treatment of benign meningiomas (see "Management of known or presumed benign (WHO grade I) meningioma")
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- Rogers L, Gilbert M, Vogelbaum MA. Intracranial meningiomas of atypical (WHO grade II) histology. J Neurooncol 2010; 99:393.
- Hanft S, Canoll P, Bruce JN. A review of malignant meningiomas: diagnosis, characteristics, and treatment. J Neurooncol 2010; 99:433.
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- Girvigian MR, Chen JC, Rahimian J, et al. Comparison of early complications for patients with convexity and parasagittal meningiomas treated with either stereotactic radiosurgery or fractionated stereotactic radiotherapy. Neurosurgery 2008; 62:A19.
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- Park HJ, Kang HC, Kim IH, et al. The role of adjuvant radiotherapy in atypical meningioma. J Neurooncol 2013; 115:241.
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- Stessin AM, Schwartz A, Judanin G, et al. Does adjuvant external-beam radiotherapy improve outcomes for nonbenign meningiomas? A Surveillance, Epidemiology, and End Results (SEER)-based analysis. J Neurosurg 2012; 117:669.
- PREOPERATIVE EVALUATION
- SURGICAL RESECTION
- ADJUVANT RADIATION THERAPY
- Malignant meningioma
- Atypical meningioma
- - Incompletely resected tumors
- - Completely resected tumors
- Ongoing protocols
- SURVEILLANCE AFTER INITIAL TREATMENT
- RECURRENT DISEASE
- SUMMARY AND RECOMMENDATIONS