Updated: 12/26/2021

Meningioma

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  • Snapshot
    • A 55-year-old woman presents to the emergency department after an unprovoked seizure. Laboratory testing is unremarkable. CT head without contrast demonstrates an extra-axial mass. An MRI brain with and without contrast demonstrates a homogenous extra-axial gadolinium enhancing mass. Neurosurgery is consulted for surgical resection.
  • Introduction
    • Overview
      • neoplasm arising from the meninges
        • most are benign
  • Epidemiology
    • Incidence
      • most common primary brain tumor
    • Risk factors
      • ionizing radiation
  • etiology
    • Associated conditions
      • neurofibromatosis type 2
      • schwannomatosis
      • multiple endocrine neoplasia type 1
  • Presentation
    • Symptoms/physical exam
      • determined by the location of the meningioma
        • these tumors are slow growing and often are asymptomatic
        • for example, parasagittal meningiomas compressing the motor strip results in bilateral leg weakness
      • seizures
        • seen in ~30% of cases
      • obstructive hydrocephalus
        • if growing in the posterior cranial fossa
  • Imaging
    • MRI brain with and without gadolinium
      • indication
        • imaging study of choice
      • findings
        • extra-axial and dural-based mass that has homogenous signal changes
        • uniformally enhanced with gadolinium
        • may have a dural tear
    • CT head with and without contrast
      • indication
        • initial imaging study of choice in patients with an acute focal neurological deficit
      • findings
        • extra-axial and dural-based mass with smooth contours
        • uniformally enhanced with contrast
  • Studies
    • Histopathology
      • indication
        • required to confirm the dagnosis and determine if the meningioma is benign or malignant
      • classified according to the World Health Organization (WHO) schema
        • WHO grade I is considered benign
        • WHO grade II and III are more likely to result in invasive disease
      • findings include
        • spindle cells arranged in a whorled pattern
        • psammoma bodies
  • Differential
    • Malignant brain neoplasm
      • differentiating factors
        • based on histological findings
          • e.g., glioblastomas will have pleomorphic tumor cells surrounding a central area of necrosis
  • Treatment
    • Medical
      • radiation therapy
        • indication
          • nonaccessible meningiomas that requires intervention
          • in atypical or malignant meningiomas to achieve source control after resection
    • Surgical
      • resection
        • indication
          • if symptomatic, meningioma is infiltrating, or resulting in substantial surrounding edema
            • lesion must be accessible to be removed
  • Complications
    • Hydrocephalus
    • Seizure
  • Prognosis
    • WHO grade I carries a favorable prognosis

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