Meningioma

Meningioma is a predominantly non-malignant tumour 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 radiotherapy is used as primary treatment. Surgery provides pathological diagnosis, which is increasingly important, as the meningioma grade may impact radiation doses and follow-up surveillance paradigms.

Radiotherapy 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 tumour of the cranial and spinal compartments. Estimates indicate that they represent 39.7% of all primary central nervous system tumours, and 55.4% of all non-malignant tumours.[1]Ostrom QT, Price M, Neff C, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2015-2019. Neuro Oncol. 2022 Oct 5;24(suppl 5):v1-v95. https://academic.oup.com/neuro-oncology/article/24/Supplement_5/v1/6742201?login=false http://www.ncbi.nlm.nih.gov/pubmed/36196752?tool=bestpractice.com ​ They are more frequent in women. Nearly 20% of tumours 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.[1]Ostrom QT, Price M, Neff C, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2015-2019. Neuro Oncol. 2022 Oct 5;24(suppl 5):v1-v95. https://academic.oup.com/neuro-oncology/article/24/Supplement_5/v1/6742201?login=false http://www.ncbi.nlm.nih.gov/pubmed/36196752?tool=bestpractice.com Malignant WHO grade 3 tumours are rare.