Management of known or presumed benign (WHO grade I) meningioma
- John K Park, MD, PhD
John K Park, MD, PhD
- Santa Barbara Neuroscience Institute
- Helen A Shih, MD
Helen A Shih, MD
- Associate Professor of Radiation Oncology
- Harvard Medical School
- Attending Radiation Oncologist
- Massachusetts General Hospital
- 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). Although most meningiomas are benign (World Health Organization [WHO] grade I), their location in the central nervous system can cause serious morbidity and/or mortality. (See "Incidence of primary brain tumors".)
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 (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.
Depending upon these characteristics, initial management for patients with a benign (WHO grade I) meningioma may consist of surgery, surgery plus radiation therapy, or radiation therapy alone. In addition, for some patients with small, asymptomatic or minimally symptomatic lesions patients may simply be monitored for evidence of tumor growth, with initial treatment deferred.
The initial management of benign (WHO grade I) meningiomas will be reviewed here. Related topics regarding the management of meningioma include:
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- APPROACH TO INITIAL THERAPY
- Presumptive diagnosis of meningioma
- Small, asymptomatic tumors
- Large or symptomatic tumors
- - Extent of resection
- - Surgical morbidity
- - Perioperative medical management
- Cerebral edema
- Deep venous thrombosis
- - RT after partial resection
- Nonresectable tumors
- - Radiation techniques
- Stereotactic radiosurgery
- Stereotactic radiotherapy
- Intensity-modulated RT
- Volumetric-modulated arc RT
- Particle therapy
- Older adults
- Patients with a history of cancer
- ONCOLOGIC AND FUNCTIONAL OUTCOMES
- Convexity meningiomas
- Skull base meningiomas
- Optic nerve sheath meningiomas
- Radiation-induced meningiomas
- Quality of life
- SURVEILLANCE AFTER INITIAL TREATMENT
- RECURRENT DISEASE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS