Last updated: June 17, 2022
Meningiomas are almost always benign, slow-growing brain tumors that arise from arachnoid cap cells of the arachnoid villi. As meningiomas may remain asymptomatic for long periods of time, they are often an incidental finding. Tumor compression can lead to a wide variety of neurological symptoms (i.e., headaches, seizures, paresthesias) that are generally specific to the structure(s) being compromised. Contrast imaging typically shows an enhanced round tumor with well-defined margins that often resembles a snowball. Management depends on the location and grade of the tumor, as well as patient-specific factors such as age, comorbidities, and accompanying symptoms. Treatment generally consists of surgical intervention, radiotherapy, or a combination of both. In some cases (e.g., asymptomatic elderly patients, or those with slow-growing meningiomas), a "watch and wait" approach with regular tumor monitoring may be safer than invasive therapy.
Meningiomas are a diverse group of brain tumors that arise from the arachnoid layer (specifically the arachnoid cap cells) and can therefore occur in any part of the CNS with a meningeal covering.
Most common benign primary brain tumor in adults 
Sex: ♀ > ♂ (2:1) 
Age: most common in patients > 65 years of age 
Epidemiological data refers to the US, unless otherwise specified.
General clinical features 
Surgical resection: first-line treatment 
- Preoperative embolization in the case of highly vascular tumors 
Skull base meningiomas have a high recurrence risk . 
Active surveillance: consider in a slow-growing asymptomatic tumor in an elderly patient 
- WHO grade I meningiomas: good prognosis, with a 5-year recurrence rate of 7–23% after resection 
- WHO grade II and III meningiomas: poor prognosis, with a 5-year recurrence rate of ∼ 50% and ∼ 75% respectively after resection 
|Meningioma recurrence rate based on the extent of tumor resection |
| Simpson grade 
|| Extent of tumor resection 
|| Recurrence rate after 10 years 
|Grade I || |
- Complete tumor resection
- Resection of the underlying dura and abnormal bone
|Grade II || |
- Complete tumor resection
- Cauterization of the dural attachment
|Grade III || |
- Complete tumor resection only
|Grade IV ||
|Grade V ||
MIB-1 index: an indirect measure of the rate of tumor growth 
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