Meningiomas

Clinical Features

• middle aged, slight female preponderance (M:F = 2:3), high progesterone receptors (increase in size with pregnancy), symptoms of increased ICP, focal deficits, usually solitary (10% multiple, likely with loss of NF2 gene/22q12 deletion)

Investigations

• CT /w contrast: homogeneous, densely enhancing, along dural border ("dural tail"), well circumscribed

• contrast enhanced MRI provides better detail

• angiography

  • most are supplied by external carotid feeders (meningeal vessels)

  • also assesses venous sinus involvement, "tumour blush" commonly seen (prolonged contrast image)

• octreotide scintigraphy: to establish if expression of somatostatin receptor

Treatment

• conservative management for non-progressive, aSx lesions

• surgery is treatment of choice if Sx or progression on sequential imaging (curative if complete resection)

• SRS may be an option for lesions <3 cm

• endovascular embolization to facilitate surgery

• SRS or XRT for recurrent atypical/malignant meningiomas

Prognosis

• >90% 5-yr survival, recurrence rate variable (often ~10-20%)

• depends on extent of resection (Simpson's classification)