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{{Meningioma}}
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{{CMG}} {{AE}}{{HL}}
{{CMG}} {{AE}} {{IO}} {{HL}}


==Overview==
==Overview==
The predominant therapy for meningioma is surgical resection. Adjunctive [[radiation therapy]] may be required among certain patients.<ref name="W">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma Accessed on September, 25 2015</ref> The Simpson criteria for meningioma correlates the degree of [[surgical resection]] completeness with the probability of post-surgical [[tumor]] recurrence.<ref name="W">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma Accessed on September, 25 2015</ref><ref name="R">Simpson grade. Radiopaedia(2015) http://radiopaedia.org/articles/simpson-grade Accessed on September, 25 2015</ref><ref name="N">Simpson Grading System. Neurosurgic.com(2015) http://www.neurosurgic.com/index.php?option=com_content&view=article&id=846:simpson-grading-system-for-removal-of-meningeomas&catid=152:usefulinfo&Itemid=603 Accessed on September, 25 2015</ref> Surgical resection is not recommended among patients with [[asymptomatic]] stable meningioma.<ref name="W">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma Accessed on September, 25 2015</ref>  
The predominant therapy for meningioma is surgical resection, it is preferred in [[symptomatic]] patients. Adjunctive [[radiation therapy]] may be required among certain patients. The decision to undergo [[surgery]] or [[Radiation therapy|radiotherapy]] depends on factors such as age, postoperative [[morbidity]], patient's preference, and more. The Simpson criteria for meningioma, which consists of 4 grades, correlates the degree of [[surgical resection]] completeness with the probability of post-surgical [[tumor]] recurrence.
 
==Indications==
 
*[[Surgery]] is not the first-line treatment option for patients with [[asymptomatic]] meningiomas.  
*It is the preferred method for treating [[symptomatic]] meningiomas.<ref name="pmid29492130">{{cite journal| author=Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF et al.| title=Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy. | journal=Asian J Neurosurg | year= 2018 | volume= 13 | issue= 1 | pages= 86-89 | pmid=29492130 | doi=10.4103/1793-5482.181115 | pmc=5820904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29492130  }} </ref>  
*The decision to undergo [[surgery]] is based on age, symptoms, radiological features, postoperative morbidity, and patient preference.<ref name="pmid29492130">{{cite journal| author=Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF et al.| title=Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy. | journal=Asian J Neurosurg | year= 2018 | volume= 13 | issue= 1 | pages= 86-89 | pmid=29492130 | doi=10.4103/1793-5482.181115 | pmc=5820904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29492130  }} </ref>


==Surgery==
==Surgery==
*Surgery is the preferred method for treating a symptomatic meningioma.<ref name="pmid29492130">{{cite journal| author=Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF et al.| title=Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy. | journal=Asian J Neurosurg | year= 2018 | volume= 13 | issue= 1 | pages= 86-89 | pmid=29492130 | doi=10.4103/1793-5482.181115 | pmc=5820904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29492130  }} </ref>
*The decision to undergo surgery is based on age, symptoms, radiological features, postoperative morbidity, and patient preference.<ref name="pmid29492130">{{cite journal| author=Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF et al.| title=Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy. | journal=Asian J Neurosurg | year= 2018 | volume= 13 | issue= 1 | pages= 86-89 | pmid=29492130 | doi=10.4103/1793-5482.181115 | pmc=5820904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29492130  }} </ref>
* The surgery is successful if the tumor is completely removed. This is considered curative.<ref name="pmid20056312">{{cite journal| author=Alexiou GA, Gogou P, Markoula S, Kyritsis AP| title=Management of meningiomas. | journal=Clin Neurol Neurosurg | year= 2010 | volume= 112 | issue= 3 | pages= 177-82 | pmid=20056312 | doi=10.1016/j.clineuro.2009.12.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20056312  }} </ref>
*When treating meningiomas, the prediction of possible recurrence and survival for malignant or transient types of meningiomas is the most important prognostic factor.<ref name="pmid30740161">{{cite journal| author=Sumkovski R, Micunovic M, Kocevski I, Ilievski B, Petrov I| title=Surgical Treatment of Meningiomas - Outcome Associated With Type of Resection, Recurrence, Karnofsky Performance Score, Mitotic Count. | journal=Open Access Maced J Med Sci | year= 2019 | volume= 7 | issue= 1 | pages= 56-64 | pmid=30740161 | doi=10.3889/oamjms.2018.503 | pmc=6352459 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30740161  }} </ref>
*As an alternative to surgery, stereotactic radiosurgery can be used either as a first line treatment or at recurrence.<ref name="pmid20056312">{{cite journal| author=Alexiou GA, Gogou P, Markoula S, Kyritsis AP| title=Management of meningiomas. | journal=Clin Neurol Neurosurg | year= 2010 | volume= 112 | issue= 3 | pages= 177-82 | pmid=20056312 | doi=10.1016/j.clineuro.2009.12.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20056312  }} </ref>
* In situations where complete resection (with low morbidity) can be achieved, and/or to decompress tumors associated with pressure symptoms, surgery is highly appropriate.<ref name="pmid30782319">{{cite journal| author=Smee R, Williams J, Kotevski D, Schneider M| title=Radiotherapy as a means of treating meningiomas. | journal=J Clin Neurosci | year= 2019 | volume= 61 | issue=  | pages= 210-218 | pmid=30782319 | doi=10.1016/j.jocn.2018.10.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30782319  }} </ref>
* Radiotherapy is an option that can be used in the treatment of meningioma but, surgery is usually preferred. This is based on symptoms, age, radiological features, postoperative morbidity, patient preference and when a definite diagnosis is necessary.<ref name="pmid29492130">{{cite journal| author=Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF et al.| title=Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy. | journal=Asian J Neurosurg | year= 2018 | volume= 13 | issue= 1 | pages= 86-89 | pmid=29492130 | doi=10.4103/1793-5482.181115 | pmc=5820904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29492130  }} </ref>
* Preoperative embolization of a meningioma may be done to help in reducing blood loss and surgical time during meningioma resection. This can cause some changes in the histology of the tumor which may lead to over grading of the tumor by the pathologist. The histological changes include: macronucleoli, necrosis, and compensatory proliferation with increased numbers of mitotic figures <ref name="pmid30954743">{{cite journal| author=Chen L, Li DH, Lu YH, Hao B, Cao YQ| title=Preoperative embolization versus direct surgery of meningiomas: A meta-analysis. | journal=World Neurosurg | year= 2019 | volume=  | issue=  | pages=  | pmid=30954743 | doi=10.1016/j.wneu.2019.02.223 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30954743  }} </ref><ref name="ComminsAtkinson2007">{{cite journal|last1=Commins|first1=Deborah L.|last2=Atkinson|first2=Roscoe D.|last3=Burnett|first3=Margaret E.|title=Review of meningioma histopathology|journal=Neurosurgical Focus|volume=23|issue=4|year=2007|pages=E3|issn=1092-0684|doi=10.3171/FOC-07/10/E3}}</ref>
* Surgical resection procedures of meningioma include:<ref name="W">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma Accessed on September, 25 2015</ref><ref name="R">Simpson grade. Radiopaedia(2015) http://radiopaedia.org/articles/simpson-grade Accessed on September, 25 2015</ref><ref name="N">Simpson Grading System. Neurosurgic.com(2015) http://www.neurosurgic.com/index.php?option=com_content&view=article&id=846:simpson-grading-system-for-removal-of-meningeomas&catid=152:usefulinfo&Itemid=603 Accessed on September, 25 2015</ref>
:* Complete meningioma resection, with excision of any involved bone, [[venous sinuses]], and dural attachments
:* Complete meningioma resection and [[coagulation]] of dural attachment
:* Partial meningioma resection sparing the [[dura]]
:* Subtotal meningioma resection
* Surgical resection is not recommended among patients with [[asymptomatic]] stable meningioma.<ref name="W">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma Accessed on September, 25 2015</ref>
* The Simpson criteria for meningioma correlates the degree of [[surgical resection]] completeness with the probability of post-surgical [[tumor]] recurrence:<ref name="W">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma Accessed on September, 25 2015</ref><ref name="R">Simpson grade. Radiopaedia(2015) http://radiopaedia.org/articles/simpson-grade Accessed on September, 25 2015</ref><ref name="N">Simpson Grading System. Neurosurgic.com(2015) http://www.neurosurgic.com/index.php?option=com_content&view=article&id=846:simpson-grading-system-for-removal-of-meningeomas&catid=152:usefulinfo&Itemid=603 Accessed on September, 25 2015</ref>


{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
*Gross total resection including the involved [[Dura mater|dura]] is the standard surgical treatment of a meningioma.<ref name="pmid27599143">{{cite journal| author=Goldbrunner R, Minniti G, Preusser M, Jenkinson MD, Sallabanda K, Houdart E et al.| title=EANO guidelines for the diagnosis and treatment of meningiomas. | journal=Lancet Oncol | year= 2016 | volume= 17 | issue= 9 | pages= e383-91 | pmid=27599143 | doi=10.1016/S1470-2045(16)30321-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27599143  }} </ref>
|valign=top|
* The [[surgery]] is successful if the [[tumor]] is completely removed. This is considered curative.<ref name="pmid20056312">{{cite journal| author=Alexiou GA, Gogou P, Markoula S, Kyritsis AP| title=Management of meningiomas. | journal=Clin Neurol Neurosurg | year= 2010 | volume= 112 | issue= 3 | pages= 177-82 | pmid=20056312 | doi=10.1016/j.clineuro.2009.12.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20056312  }} </ref>
*When treating meningiomas, the prediction of possible recurrence and survival for [[malignant]] or transient types of meningiomas are the most important prognostic factors.<ref name="pmid30740161">{{cite journal| author=Sumkovski R, Micunovic M, Kocevski I, Ilievski B, Petrov I| title=Surgical Treatment of Meningiomas - Outcome Associated With Type of Resection, Recurrence, Karnofsky Performance Score, Mitotic Count. | journal=Open Access Maced J Med Sci | year= 2019 | volume= 7 | issue= 1 | pages= 56-64 | pmid=30740161 | doi=10.3889/oamjms.2018.503 | pmc=6352459 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30740161  }} </ref>
*As an alternative to [[surgery]], [[stereotactic radiosurgery]] can be used either as a first line treatment or at recurrence.<ref name="pmid20056312">{{cite journal| author=Alexiou GA, Gogou P, Markoula S, Kyritsis AP| title=Management of meningiomas. | journal=Clin Neurol Neurosurg | year= 2010 | volume= 112 | issue= 3 | pages= 177-82 | pmid=20056312 | doi=10.1016/j.clineuro.2009.12.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20056312  }} </ref>
* In situations where complete resection (with low morbidity) can be achieved, and/or to decompress [[Tumor|tumors]] associated with pressure symptoms, [[surgery]] is highly appropriate.<ref name="pmid30782319">{{cite journal| author=Smee R, Williams J, Kotevski D, Schneider M| title=Radiotherapy as a means of treating meningiomas. | journal=J Clin Neurosci | year= 2019 | volume= 61 | issue=  | pages= 210-218 | pmid=30782319 | doi=10.1016/j.jocn.2018.10.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30782319  }} </ref>
* [[Radiation therapy|Radiotherapy]] is an option that can be used in the treatment of meningioma but, [[surgery]] is usually preferred. This is based on symptoms, age, radiological features, postoperative morbidity, patient preference and when a definite diagnosis is necessary.<ref name="pmid29492130">{{cite journal| author=Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF et al.| title=Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy. | journal=Asian J Neurosurg | year= 2018 | volume= 13 | issue= 1 | pages= 86-89 | pmid=29492130 | doi=10.4103/1793-5482.181115 | pmc=5820904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29492130  }} </ref>
* Preoperative embolization of a meningioma may be done to help in reducing blood loss and surgical time during meningioma resection. This can cause some changes in the histology of the [[tumor]] which may lead to over grading of the [[tumor]] by the pathologist. The histological changes include macronucleoli, [[necrosis]], and compensatory [[proliferation]] with increased numbers of mitotic figures.<ref name="pmid30954743">{{cite journal| author=Chen L, Li DH, Lu YH, Hao B, Cao YQ| title=Preoperative embolization versus direct surgery of meningiomas: A meta-analysis. | journal=World Neurosurg | year= 2019 | volume=  | issue=  | pages=  | pmid=30954743 | doi=10.1016/j.wneu.2019.02.223 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30954743  }} </ref><ref name="ComminsAtkinson2007">{{cite journal|last1=Commins|first1=Deborah L.|last2=Atkinson|first2=Roscoe D.|last3=Burnett|first3=Margaret E.|title=Review of meningioma histopathology|journal=Neurosurgical Focus|volume=23|issue=4|year=2007|pages=E3|issn=1092-0684|doi=10.3171/FOC-07/10/E3}}</ref>
* Microsurgical resection may be done for [[posterior fossa]] meningiomas.<ref name="pmid23293666">{{cite journal| author=Velho V, Agarwal V, Mally R, Palande DA| title=Posterior fossa meningioma "our experience" in 64 cases. | journal=Asian J Neurosurg | year= 2012 | volume= 7 | issue= 3 | pages= 116-24 | pmid=23293666 | doi=10.4103/1793-5482.103710 | pmc=3532757 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23293666  }} </ref>
* Modern image-guided [[minimally invasive surgery]] may be done for cerebral convexity meningiomas.<ref name="pmid18812953">{{cite journal| author=Morokoff AP, Zauberman J, Black PM| title=Surgery for convexity meningiomas. | journal=Neurosurgery | year= 2008 | volume= 63 | issue= 3 | pages= 427-33; discussion 433-4 | pmid=18812953 | doi=10.1227/01.NEU.0000310692.80289.28 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18812953  }} </ref>
* The approach taken to resect a meningioma may be done based on the location of the tumor:<ref name="pmid23293666">{{cite journal| author=Velho V, Agarwal V, Mally R, Palande DA| title=Posterior fossa meningioma "our experience" in 64 cases. | journal=Asian J Neurosurg | year= 2012 | volume= 7 | issue= 3 | pages= 116-24 | pmid=23293666 | doi=10.4103/1793-5482.103710 | pmc=3532757 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23293666  }} </ref>
:* Midline suboccipital [[craniectomy]] with C1 [[laminectomy]] is preferred for [[foramen magnum]] meningiomas.
:* Retromastoid suboccipital [[craniectomy]] is preferred for [[cerebellopontine angle]], petroclival, lateral tentorial, and [[jugular foramen]] meningiomas.
* The Simpson criteria for meningioma correlates the degree of [[surgical resection]] completeness with the probability of post-surgical [[tumor]] recurrence:<ref name="pmid25343186">{{cite journal| author=Rogers L, Barani I, Chamberlain M, Kaley TJ, McDermott M, Raizer J et al.| title=Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review. | journal=J Neurosurg | year= 2015 | volume= 122 | issue= 1 | pages= 4-23 | pmid=25343186 | doi=10.3171/2014.7.JNS131644 | pmc=5062955 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25343186  }} </ref>
 
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
| valign="top" |
|+
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Simpson Grade}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Simpson Grade}}
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:Grade 1
:Grade 1
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
:Complete tumor resection including removal of dural attachments and abnormal bone
:Complete [[tumor]] resection including removal of [[Dura mater|dural]] attachments and abnormal bone
| style="padding: 5px 5px; background: #F5F5F5;text-align: center;" |
| style="padding: 5px 5px; background: #F5F5F5;text-align: center;" |
9%
9%
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:Grade 2
:Grade 2
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
:Complete tumor resection and coagulation of dural attachments
:Complete [[tumor]] resection and [[coagulation]] of [[Dura mater|dural]] attachments
| style="padding: 5px 5px; background: #F5F5F5; text-align: center;;" |
| style="padding: 5px 5px; background: #F5F5F5; text-align: center;;" |
19%
19%
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:Grade 3
:Grade 3
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| style="padding: 5px 5px; background: #F5F5F5;" |
:Complete tumor resection without resection or coagulation of dural attachments or extradural extensions (e.g invaded or hyperostotic bone)
:Complete [[tumor]] resection without resection or [[coagulation]] of [[Dura mater|dural]] attachments or extradural extensions (e.g invaded or [[Hyperostosis|hyperostotic]] bone)
| style="padding: 5px 5px; background: #F5F5F5; text-align: center;;" |
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29%
29%
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:Grade 4
:Grade 4
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:Subtotal resection (partial tumor resection)
:Subtotal resection (partial [[tumor]] resection)
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| style="padding: 5px 5px; background: #F5F5F5; text-align: center;" |
40%
40%

Latest revision as of 14:42, 10 September 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ifeoma Odukwe, M.D. [2] Haytham Allaham, M.D. [3]

Overview

The predominant therapy for meningioma is surgical resection, it is preferred in symptomatic patients. Adjunctive radiation therapy may be required among certain patients. The decision to undergo surgery or radiotherapy depends on factors such as age, postoperative morbidity, patient's preference, and more. The Simpson criteria for meningioma, which consists of 4 grades, correlates the degree of surgical resection completeness with the probability of post-surgical tumor recurrence.

Indications

  • Surgery is not the first-line treatment option for patients with asymptomatic meningiomas.
  • It is the preferred method for treating symptomatic meningiomas.[1]
  • The decision to undergo surgery is based on age, symptoms, radiological features, postoperative morbidity, and patient preference.[1]

Surgery

  • Gross total resection including the involved dura is the standard surgical treatment of a meningioma.[2]
  • The surgery is successful if the tumor is completely removed. This is considered curative.[3]
  • When treating meningiomas, the prediction of possible recurrence and survival for malignant or transient types of meningiomas are the most important prognostic factors.[4]
  • As an alternative to surgery, stereotactic radiosurgery can be used either as a first line treatment or at recurrence.[3]
  • In situations where complete resection (with low morbidity) can be achieved, and/or to decompress tumors associated with pressure symptoms, surgery is highly appropriate.[5]
  • Radiotherapy is an option that can be used in the treatment of meningioma but, surgery is usually preferred. This is based on symptoms, age, radiological features, postoperative morbidity, patient preference and when a definite diagnosis is necessary.[1]
  • Preoperative embolization of a meningioma may be done to help in reducing blood loss and surgical time during meningioma resection. This can cause some changes in the histology of the tumor which may lead to over grading of the tumor by the pathologist. The histological changes include macronucleoli, necrosis, and compensatory proliferation with increased numbers of mitotic figures.[6][7]
  • Microsurgical resection may be done for posterior fossa meningiomas.[8]
  • Modern image-guided minimally invasive surgery may be done for cerebral convexity meningiomas.[9]
  • The approach taken to resect a meningioma may be done based on the location of the tumor:[8]
  • The Simpson criteria for meningioma correlates the degree of surgical resection completeness with the probability of post-surgical tumor recurrence:[10]
Simpson Grade Completeness of Resection 10-Year Recurrence
Grade 1
Complete tumor resection including removal of dural attachments and abnormal bone

9%

Grade 2
Complete tumor resection and coagulation of dural attachments

19%

Grade 3
Complete tumor resection without resection or coagulation of dural attachments or extradural extensions (e.g invaded or hyperostotic bone)

29%

Grade 4
Subtotal resection (partial tumor resection)

40%

References

  1. 1.0 1.1 1.2 Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF; et al. (2018). "Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy". Asian J Neurosurg. 13 (1): 86–89. doi:10.4103/1793-5482.181115. PMC 5820904. PMID 29492130.
  2. Goldbrunner R, Minniti G, Preusser M, Jenkinson MD, Sallabanda K, Houdart E; et al. (2016). "EANO guidelines for the diagnosis and treatment of meningiomas". Lancet Oncol. 17 (9): e383–91. doi:10.1016/S1470-2045(16)30321-7. PMID 27599143.
  3. 3.0 3.1 Alexiou GA, Gogou P, Markoula S, Kyritsis AP (2010). "Management of meningiomas". Clin Neurol Neurosurg. 112 (3): 177–82. doi:10.1016/j.clineuro.2009.12.011. PMID 20056312.
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