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Tumors of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Many meningiomas are discovered when small and asymptomatic when a CT or MRI is performed for an unrelated reason (e.g. trauma, migraine, or stroke). For symptomatic meningioma, the symptoms will depend on the location and size of the lesion. Most symptoms are of slow and insidious onset; because of slow growth, symptomatic meningiomas are often very large at the time of diagnosis.
Central Nervous System
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Radiotherapy is effective in the management of meningioma. It is usually given in the adjuvant setting following an incomplete resection where further surgery might prove to be difficult, after multiple relapses following surgery, or when the histology is unfavorable.70
Choroid Plexus Tumors and Meningiomas
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Kenneth K. Wong, Elwira Szychot, Jennifer A. Cotter, Mark Krieger
Meningiomas have characteristic appearances on both MRI and CT scans. On MRI, a typical meningioma is an extra-axial, dural-based mass that is isointense or hypointense to gray matter on T1 and isointense or hyperintense on proton density and T2-weighted images. There is strong, homogeneous contrast enhancement after gadolinium administration. Most meningiomas show a characteristic marginal dural thickening that tapers peripherally, known as the “tail” sign; however, this is rare in pediatric meningiomas. On CT scans, the typical meningioma is a well-defined extra-axial mass that displaces the normal brain. They are smooth in contour, adjacent to dural structures, and sometimes calcified or multi-lobulated. Isointensity with normal surrounding brain may make diagnosis difficult on a non-contrasted scan, but intravenous contrast administration results in uniformly bright enhancement. Secondary involvement of adjacent bone (reactive sclerosis, invasion, erosion) is uncommon in convexity meningiomas, but occurs in up to one-half of skull base tumors.123
Overview and recent advances in incidental meningioma
Published in Expert Review of Anticancer Therapy, 2023
Olivia Näslund, Per Sveino Strand, Thomas Skoglund, Ole Solheim, Asgeir S. Jakola
Assumed to arise from the arachnoid cap cells in the soft coverings of the brain, meningioma is the most frequent primary intracranial tumor. The distribution of meningioma exhibits an anterior to posterior gradient in the brain [1]. The WHO classification of tumors of the central nervous system describes three grades of meningiomas, with approximate distribution by grade as follows: WHO grade 1, 80%; WHO grade 2, 18%; and WHO grade 3, 2% [2]. Most arise sporadically, although some are familial or arise after radiotherapy [3]. For symptomatic meningiomas, there is no pathognomonic clinical presentation and symptoms generally depend on tumor location [4]. Meningiomas presenting with symptoms such as focal neurological deficits and seizures have clear management guidelines, with surgery as fist-line treatment [5].
Biomarkers for differentiating grade II meningiomas from grade I: a systematic review
Published in British Journal of Neurosurgery, 2021
Agbolahan A. Sofela, Lucy McGavin, Peter C. Whitfield, C. Oliver Hanemann
Besides MRI, nuclear imaging is a potential modality for diagnosing/staging meningiomas. Mitamura et al assessed the PET uptake of 2-deoxy-2-18F-fluoro-d-glucose, FDG (9.25±2.16 in grade II, versus 5.76±2.23 in grade I meningiomas; p=0.003) and L-[methyl-11C]-methionine, MET (8.70±2.59 in grade II, versus 5.49±1.02 in grade I meningiomas; p=0.002) and described significantly higher maximum tumour standardized uptake values in the grade II tumours,61 highlighting the potential use of FDG and MET PET/CT in predicting meningioma grade in a pre-operative setting. However, MET PET/CT has been shown to be superior to FDG PET/CT when assessing for recurrent or residual grade II meningiomas in the post-operative setting.61,62
Pharmacotherapeutic options for atypical meningiomas
Published in Expert Opinion on Pharmacotherapy, 2019
Syed Ali Ahsan, Kassem Chendeb, Christos Profyris, Charles Teo, Michael E. Sughrue
Benign meningiomas have a good prognosis with a 5-year survival rate of 97.5%. Contrastingly, atypical meningiomas have a 5-year survival rate of 75% and malignant meningiomas have a rate of 32% with median survival being around 142.5 months and 138.5 months, respectively, [2,6]. Surgery when possible is the primary method to treat meningiomas of all grades; surgery can be followed up with radiation therapy, radiosurgery a potential chemotherapy [7]. Whilst largely unsuccessful there are some chemotherapeutic agents that have shown potential [8]. The main problems encountered when addressing this issue include the heterogeneity of atypical meningiomas, the changing definitions of the grades, lack of large randomized trials/phase III trials for chemotherapeutic drugs and general lack of understanding of the pathways that regulate meningioma growth. Many of the studies report on mixed cohorts with benign, atypical and malignant meningioma patients all treated with a particular pharmaceutical agent, we have included these in our review. Furthermore, studies that have looked at recurrent benign meningiomas have also been included as they may also be beneficial in treating atypical meningiomas.