Treatment of meningiomas

INTRODUCTION

Meningiomas arise from the arachnoid cap cells of the arachnoid villi of the meninges. Approximately 90 percent of meningiomas are benign, while 5 to 10 percent are atypical (WHO grade II, (table 1) and less than 2 percent are classified as malignant (WHO grade III, also termed anaplastic). (See "Classification of brain tumors", section on 'Histopathologic classification'.)

Meningiomas, the second most frequent primary brain tumors after gliomas, occur with an incidence of approximately six per 100,000 and account for approximately 13 to 30 percent of primary intracranial tumors [1-3]. (See "Incidence of primary brain tumors".)

The treatment of meningiomas will be reviewed here. The biology, pathology, clinical presentation, and diagnosis of meningioma are discussed separately. (See "Biology and clinical features of meningioma".)

OVERVIEW OF MANAGEMENT

The primary management of a meningioma depends upon the signs or symptoms it produces, the age of the patient, and the location and size of the tumor. Depending upon these factors, long-term management may involve a combination of several modalities:

• Conservative management — For asymptomatic patients in whom tumor growth is likely to be indolent and unlikely to cause symptoms, careful observation without active intervention may be the most appropriate option. This is often the case when meningiomas are incidentally diagnosed by imaging studies of the brain that are obtained for unrelated causes (eg, head injury) (see 'Conservative management' below.
• Surgery — Upfront complete resection of the tumor is often possible. More limited resections are performed when tumors are not fully surgically accessible or when there is concern for potential damage to normal neurologic structures. Surgery also plays a role in recurrent tumors. (See 'Surgery' below.)