Evaluation and management of suspected meningioma

This is an approach to the evaluation and initial management of patients with a suspected meningioma. While meningioma is by far the most common cause of a discrete, dural-based mass lesion, the differential diagnosis also includes other tumors (eg, metastatic cancer, lymphoid malignancy, solitary fibrous tumor), inflammatory lesions such as sarcoidosis, and infections such as tuberculosis. Patients who are being considered for observation or empiric radiation may benefit from more extensive systemic evaluation to help exclude alternative etiologies, particularly when imaging features are atypical.

abd: abdomen; CT: computed tomography; MRI: magnetic resonance imaging.

* Surgical candidacy varies based on tumor location (eg, deep versus superficial, proximity to critical structures), imaging evidence of invasion, and presurgical status of the patient. Refer to UpToDate topic review for details.

¶ The threshold for intervention may be lower for young and healthy patients, based on the expectation that tumor progression will inevitably require active treatment. Some young patients with small, asymptomatic tumors may reasonably choose early definitive intervention for a presumed meningioma rather than active surveillance.

Δ For nonresectable tumors with atypical neuroimaging features, biopsy may be indicated to confirm diagnosis before proceeding with radiation. Some large, nonresectable tumors may not be safe candidates for radiation without partial tumor debulking first.

◊ Empiric radiation may be a reasonable alternative in selected patients who wish to avoid surgery, such as those with small to intermediate-sized tumors that are typical in appearance for meningioma.

§ Postoperative management depends upon meningioma grade and extent of resection. Refer to UpToDate topic reviews on the treatment of benign, atypical, and malignant meningiomas for details.

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Evaluation and management of suspected meningioma