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Meningioma

Last updated: January 8, 2021

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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 [1][2]
  • Sex: > (2:1) [3]
  • Age: most common in patients > 65 years of age [4]

Epidemiological data refers to the US, unless otherwise specified.

Clinical features based on meningioma location [6]
Location Frequency Clinical features
Supratentorial convex surface [8][9]
  • ∼ 20%
Parasagittal angle [10]
  • ∼ 19%
Falx cerebri [10]
  • ∼ 8%
Sphenoid wings [11]
  • ∼ 20%
Posterior cranial fossa [12]
  • ∼ 10%
Olfactory groove [13]
  • ∼ 10%
Foramen magnum [14]
  • ∼ 2%
Intraventricular [12]
  • < 1%
Spinal meningioma [15]
  • ∼ 10%

MRI (imaging modality of choice)

  • Plain MRI findings [16]
  • Contrast MRI findings [16]
    • Significant homogenous enhancement of the meningioma
    • Sunburst or spoke-wheel appearance [17]
    • Spinal meningioma: ginkgo-leaf sign [18]
    • En plaque meningioma: a rare benign subtype that is characterized by diffuse carpet-like growth along the dural layer

CT scan [19]

  • CT scans performed to investigate unexplained headaches or seizures are usually the first to pick up incidental meningiomas.
  • Findings

Brain tumor biopsy [6]

  • May be performed if the tumor is inoperable or imaging is inconclusive
  • Most meningiomas are removed surgically without a prior biopsy. [20]

Gross findings

Microscopic findings

  • Mesenchymal origin (arachnoid cap cells)
  • Whorls of meningothelial cells (onion peel arrangement) [21]
  • Psammoma bodies [22]
  • Increased vascularity [23]

WHO classification of meningiomas

  • There are 15 histological subtypes of meningiomas.
  • Most meningiomas are benign (WHO grade I) tumors.
WHO classification of meningiomas [6][22]
WHO grade Frequency Histopathological criteria Subtypes
Grade I (benign)
  • 80–85% of all meningiomas
  • Transitional (mixed type)
  • Meningothelial (classical meningioma)
  • Fibrous
  • Psammomatous
  • Angiomatous
  • Microcystic
  • Lymphoplasmacytic
  • Secretory
  • Metaplastic
Grade II (atypical)
  • 15–20% of all meningiomas
Grade III (malignant)
  • < 2% of all meningiomas
  • Surgical resection: first-line treatment [22]
    • Preoperative embolization in the case of highly vascular tumors [23]
    • Skull base meningiomas have a high recurrence risk . [24]
  • Radiotherapy [22]
  • Active surveillance: consider in a slow-growing asymptomatic tumor in an elderly patient [6]
  • WHO grade I meningiomas: good prognosis, with a 5-year recurrence rate of 7–23% after resection [22][26]
  • WHO grade II and III meningiomas: poor prognosis, with a 5-year recurrence rate of ∼ 50% and ∼ 75% respectively after resection [22][26]
Meningioma recurrence rate based on the extent of tumor resection
Simpson grade [22] Extent of tumor resection [22] Recurrence rate after 10 years [27]
Grade I
  • Complete tumor resection
  • Resection of the underlying dura and abnormal bone
  • ∼ 5%
Grade II
  • Complete tumor resection
  • Cauterization of the dural attachment
  • ∼ 20%
Grade III
  • Complete tumor resection only
  • ∼ 30%
Grade IV
  • Subtotal resection
  • ∼ 35%
Grade V
  • 100%
  • MIB-1 index: an indirect measure of the rate of tumor growth [28][29]
    • MIB-1 is a monoclonal antibody used to assay the antigen Ki-67 (a nuclear protein seen in proliferating cells).
    • MIB-1 index > 4% is associated with a higher meningioma recurrence rate.
  1. Norden AD, Drappatz J, Wen PY. Advances in meningioma therapy. Curr Neurol Neurosci Rep. 2009; 9 (3): p.231-240.
  2. Ostrom QT, Gittleman H, Fulop J, et al. CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2008-2012. Neuro Oncol. 2015; 17 (suppl 4): p.iv1-iv62. doi: 10.1093/neuonc/nov189 . | Open in Read by QxMD
  3. Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma.. J Neurooncol. 2010; 99 (3): p.307-14. doi: 10.1007/s11060-010-0386-3 . | Open in Read by QxMD
  4. Holleczek B, Zampella D, Urbschat S, et al. Incidence, mortality and outcome of meningiomas: A population-based study from Germany. Cancer Epidemiology. 2019; 62 : p.101562. doi: 10.1016/j.canep.2019.07.001 . | Open in Read by QxMD
  5. Perry A. Meningiomas. Elsevier ; 2010 : p. 185-217
  6. Patient Information: Meningiomas. http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Meningiomas.aspx. Updated: June 1, 2012. Accessed: January 18, 2017.
  7. Kim JH, Lee SH, Rhee CH, Park SY, Lee JH. Loss of heterozygosity on chromosome 22q and 17p correlates with aggressiveness of meningiomas. J Neurooncol. 1998; 40 (2): p.101-106.
  8. Kazemi NJ, Kaye AH. Convexity Meningiomas. Springer London ; 2009 : p. 301-307
  9. Morokoff AP, Zauberman J, Black PM. SURGERY FOR CONVEXITY MENINGIOMAS. Neurosurgery. 2008; 63 (3): p.427-434. doi: 10.1227/01.neu.0000310692.80289.28 . | Open in Read by QxMD
  10. Elzarief AA, Ibrahim MF. Long-term follow-up of motor function deterioration following microsurgical resection of middle third parasagittal and falx meningioma. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2018; 54 (1). doi: 10.1186/s41983-018-0013-3 . | Open in Read by QxMD
  11. Del Toro E, Risbud A, Khosravani N, Vengerovich G, Archilla A. Sphenoid Wing Meningioma Presenting as Sudden Sensorineural Hearing Loss: A Case Report and Literature Review. Ear, Nose & Throat Journal. 2020 : p.014556132090573. doi: 10.1177/0145561320905731 . | Open in Read by QxMD
  12. Bos D, Poels MMF, Adams HHH, et al. Prevalence, Clinical Management, and Natural Course of Incidental Findings on Brain MR Images: The Population-based Rotterdam Scan Study. Radiology. 2016; 281 (2): p.507-515. doi: 10.1148/radiol.2016160218 . | Open in Read by QxMD
  13. Nakamura M, Struck M, Roser F, Vorkapic P, Samii M. Olfactory Groove Meningiomas: Clinical Outcome and Recurrence Rates after Tumor Removal Through the Frontolateral and Bifrontal Approach. Neurosurgery. 2007; 60 (5): p.844-852. doi: 10.1227/01.neu.0000255453.20602.80 . | Open in Read by QxMD
  14. Mostofi K. Foramen Magnum Meningioma: Some Anatomical and Surgical Remarks through Five Cases. Asian Spine Journal. 2015; 9 (1): p.54. doi: 10.4184/asj.2015.9.1.54 . | Open in Read by QxMD
  15. Ben Nsir A, Boughamoura M, Mahmoudi H, Kilani M, Hattab N. Uncommon Progression of an Extradural Spinal Meningioma. Case Reports in Surgery. 2014; 2014 : p.1-4. doi: 10.1155/2014/630876 . | Open in Read by QxMD
  16. Watts J, Box G, Galvin A, Brotchie P, Trost N, Sutherland T. Magnetic resonance imaging of meningiomas: a pictorial review.. Insights into imaging. 2014; 5 (1): p.113-22. doi: 10.1007/s13244-013-0302-4 . | Open in Read by QxMD
  17. Kunimatsu A, Kunimatsu N, Kamiya K, Katsura M, Mori H, Ohtomo K. Variants of meningiomas: a review of imaging findings and clinical features. Japanese Journal of Radiology. 2016; 34 (7): p.459-469. doi: 10.1007/s11604-016-0550-6 . | Open in Read by QxMD
  18. Yamaguchi S, Takeda M, Takahashi T, et al. Ginkgo leaf sign: a highly predictive imaging feature of spinal meningioma. Journal of Neurosurgery: Spine. 2015; 23 (5): p.642-646. doi: 10.3171/2015.3.spine1598 . | Open in Read by QxMD
  19. Lyndon D, Lansley JA, Evanson J, Krishnan AS. Dural masses: meningiomas and their mimics.. Insights into imaging. 2019; 10 (1): p.11. doi: 10.1186/s13244-019-0697-7 . | Open in Read by QxMD
  20. Meningioma. https://rarediseases.org/rare-diseases/meningioma/. . Accessed: January 7, 2021.
  21. Huang S, Chen L, Mao Y, Tong H. Primary pulmonary meningioma. Medicine. 2017; 96 (19): p.e6474. doi: 10.1097/md.0000000000006474 . | Open in Read by QxMD
  22. Buerki RA, Horbinski CM, Kruser T, Horowitz PM, James CD, Lukas RV. An overview of meningiomas. Future Oncology. 2018; 14 (21): p.2161-2177. doi: 10.2217/fon-2018-0006 . | Open in Read by QxMD
  23. Martin AJ, Cha S, Higashida RT, et al. Assessment of Vasculature of Meningiomas and the Effects of Embolization with Intra-arterial MR Perfusion Imaging: A Feasibility Study. American Journal of Neuroradiology. 2007; 28 (9): p.1771-1777. doi: 10.3174/ajnr.a0647 . | Open in Read by QxMD
  24. Mendenhall WM, Friedman WA, Amdur RJ, Foote KD. Management of benign skull base meningiomas: a review.. Skull Base. 2004; 14 (1): p.53-60; discussion 61. doi: 10.1055/s-2004-821364 . | Open in Read by QxMD
  25. Kondziolka D, Levy EI, Niranjan A, Flickinger JC, Lunsford LD. Long-term outcomes after meningioma radiosurgery: physician and patient perspectives. J Neurosurg. 1999; 91 (1): p.44-50.
  26. Violaris K, Katsarides V, Sakellariou P. The Recurrence Rate in Meningiomas: Analysis of Tumor Location, Histological Grading, and Extent of Resection. Open Journal of Modern Neurosurgery. 2012; 2 : p.6-10. doi: 10.4236/ojmn.2012.21002 . | Open in Read by QxMD
  27. Nanda A, Bir SC, Maiti TK, Konar SK, Missios S, Guthikonda B. Relevance of Simpson grading system and recurrence-free survival after surgery for World Health Organization Grade I meningioma. J Neurosurg. 2017; 126 (1): p.201-211. doi: 10.3171/2016.1.jns151842 . | Open in Read by QxMD
  28. Liu N, Song S-Y, Jiang J-B, Wang T-J, Yan C-X. The prognostic role of Ki-67/MIB-1 in meningioma. Medicine. 2020; 99 (9): p.e18644. doi: 10.1097/md.0000000000018644 . | Open in Read by QxMD
  29. Abry E, Thomassen IØ, Salvesen ØO, Torp SH. The significance of Ki-67/MIB-1 labeling index in human meningiomas: A literature study. Pathology - Research and Practice. 2010; 206 (12): p.810-815. doi: 10.1016/j.prp.2010.09.002 . | Open in Read by QxMD