Management of multiple meningiomas

Abstract

OBJECTIVE Multiple meningiomas account for 1%-10% of meningiomas. This study describes epidemiological aspects of the disease and its management, which is more challenging than for single tumors. METHODS A consecutive series of adult patients with ≥ 2 spatially separated meningiomas was reviewed. Patients with neurofibromatosis Type 2 were excluded. The authors collected clinical, imaging, histological, and treatment data to obtain information on epidemiology, management options, and outcomes of active treatment and surveillance. RESULTS A total of 133 consecutive patients were included over 25 years, with a total of 395 synchronous and 53 metachronous meningiomas, and a median of 2 tumors per patient. One hundred six patients had sporadic disease, 26 had radiation-induced disease, and 1 had familial meningiomatosis. At presentation, half of the patients were asymptomatic. In terms of their maximum cross-sectional diameter, the tumors were small (≤ 2 cm) in 67% and large (> 4 cm) in 11% of the meningiomas. Fifty-four patients had upfront treatment, and 31 had delayed treatment after an observation period (mean 4 years). One in 4 patients had ≥ 2 meningiomas treated. Overall, 64% of patients had treatment for 142 tumors-67 with surgery and 18 with radiotherapy alone. The mean follow-up was 7 years, with 13% of treated patients receiving salvage therapy. Approximately 1 in 4 patients who underwent surgery had ≥ 1 WHO Grade II or III meningioma. Meningiomas of different histological subtypes and grades in the same patient were not uncommon. CONCLUSIONS Multiple meningiomas are often asymptomatic, probably because the majority are small and a significant proportion are induced by radiation. Approximately two-thirds of patients with multiple meningiomas require therapy, but only one-third of all meningiomas need active treatment. The authors recommend surveillance for stable and asymptomatic meningiomas and therapy for those that are symptomatic or growing.

<p>Whole exome sequencing of multiple meningiomas with varying histopathological presentation in one patient revealed distinctive somatic mutation burden and independent clonal origins</p>

“…Similarly, Liu et al11 showed the coexistence of fibrous meningioma (WHO grade I) and atypical meningioma (WHO grade II) in the same patient. More recently, Tsermoulas et al29 reviewed a total of 133 consecutive patients with MMs for over 25 years and 18 patients had surgical removal of more than one meningioma. Among these patients, 4 had tumors of different grades and 6 patients had meningiomas of different histological types.…”

Meningiomas with different histological grade in the same patient

“…[ 16 , 17 ] Multiple meningiomas account for 1% to 10% of meningiomas. [ 18 ] A widely accepted hypothesis of multicentric meningioma indicates that tumoral cell clone spread through cerebrospinal fluid and hematogenous expansion. It's rare to find different sporadic patterns in 1 patient.…”

Long-Term Clinical Outcome of First Recurrence Skull Base Meningiomas

“…Tumor size was analyzed using the longest diameter, as described previously [21,22]. For multiple meningiomas, tumor size was defined as the longest diameter of the largest one [23]. The removal rate was validated using postoperative routine head computed tomography at 7 days after the operation.…”