Meningioma: A Review of Epidemiology, Pathology, Diagnosis, Treatment, and Future Directions

Abstract

Meningiomas are the most common intracranial tumor, making up more than a third of all primary central nervous system (CNS) tumors. They are mostly benign tumors that can be observed or preferentially treated with gross total resection that provides good outcomes. Meningiomas with complicated histology or in compromising locations has proved to be a challenge in treating and predicting prognostic outcomes. Advances in genomics and molecular characteristics of meningiomas have uncovered potential use for more accurate grading and prediction of prognosis and recurrence. With the study and detection of genomic aberrancies, specific biologic targets are now being trialed for possible management of meningiomas that are not responsive to standard surgery and radiotherapy treatment. This review summarizes current epidemiology, etiology, molecular characteristics, diagnosis, treatments, and current treatment trials.

High-Throughput Mechanistic Screening of Epigenetic Compounds for the Potential Treatment of Meningiomas

“…Our cohort had only one patient known to have received radiation and four cases where this was not specified. Female preponderance of the disease is reported to be 2.27:1 [ 41 , 42 ], and our cohort was ~3.5:1, female to male. Thus, ratios of tumor grades, female-to-male skew of patients, rates of recurrence, and use radiation therapy among our cohort are remarkably similar to those categories found in larger population studies.…”

“…The total cohort exceeded 30 tumors and therefore was an appropriate size to apply standard population statistics; however, a significant limitation is the lack of population to appropriately power sub-analyses. Nonetheless, this cohort reflects the generalized epidemiologic trends of the disease: in terms of ratios of tumor grades, 80–85% grade 1 tumors are reported; our cohort was ~79% grade 1 tumors; 15–20% grade 2 tumors are reported; our cohort was ~16% grade 2; 1–2% grade 3 tumors are reported; our single grade 3 tumor would represent ~3% [ 41 , 42 ]. Recurrence rates vary according to tumor grade and extent of resection, but 5-year recurrence rates range from as low as 7% (grade 1) to as high as 78% (grade 3) [ 42 ].…”

“…Nonetheless, this cohort reflects the generalized epidemiologic trends of the disease: in terms of ratios of tumor grades, 80–85% grade 1 tumors are reported; our cohort was ~79% grade 1 tumors; 15–20% grade 2 tumors are reported; our cohort was ~16% grade 2; 1–2% grade 3 tumors are reported; our single grade 3 tumor would represent ~3% [ 41 , 42 ]. Recurrence rates vary according to tumor grade and extent of resection, but 5-year recurrence rates range from as low as 7% (grade 1) to as high as 78% (grade 3) [ 42 ]. Without subclassification according to patients’ previous surgical and clinical parameters, and reflecting our short time course of tumor collection (~9 months), < 10% of our cohort presented with recurrent tumors, and no individuals with primary tumors within our cohort recurred during the course of this study.…”

“…Without subclassification according to patients’ previous surgical and clinical parameters, and reflecting our short time course of tumor collection (~9 months), < 10% of our cohort presented with recurrent tumors, and no individuals with primary tumors within our cohort recurred during the course of this study. Radiation therapy likewise varies as a treatment, mostly for sub-total resections and higher tumor grades, while most grade 1 tumors are not radiated [ 41 , 42 ], making it difficult to generalize. Our cohort had only one patient known to have received radiation and four cases where this was not specified.…”

Predict Treatment Response by Magnetic Resonance Diffusion Weighted Imaging: A Preliminary Study on 46 Meningiomas Treated with Proton-Therapy

“…Meningiomas (MN) are extra-axial tumours arising from the inner layer of the dura. They are the most common adult intracranial tumour, and most of them are benign [ 1 ]. The treatment strategy for MN includes observation, surgery, and radiation therapy [ 2 ].…”