The management of incidental meningioma: An unresolved clinical conundrum

Abstract

The widespread availability and use of brain magnetic resonance imaging and computed tomography has led to an increase in the frequency of incidental meningioma diagnoses. Most incidental meningioma are small, demonstrate indolent behavior during follow-up, and do not require intervention. Occasionally, meningioma growth causes neurological deficits or seizures prompting surgical or radiation treatment. They may cause anxiety to the patient and present a management dilemma for the clinician. The questions for both patient and clinician are “will the meningioma grow and cause symptoms such that it will require treatment within my lifetime?” and “will deferment of treatment result in greater treatment-related risks and lower chance of cure?.” International consensus guidelines recommend regular imaging and clinical follow-up, but the duration is not specified. Upfront treatment with surgery or stereotactic radiosurgery/radiotherapy may be recommended but this is potentially an overtreatment, and its benefits must be balanced against the risk of related adverse events. Ideally, treatment should be stratified based on patient and tumor characteristics, but this is presently hindered by low-quality supporting evidence. This review discusses risk factors for meningioma growth, proposed management strategies, and ongoing research in the field.

Review of metastasis to meningiomas with case examples

“…The wait-and-watch approach is often used in patients with newly diagnosed incidental meningiomas as most incidental meningiomas are small, demonstrate indolent behavior during follow-up, and do not require intervention ( Islim et al, 2023 ). In patients with diagnosed cancer clinicians should perhaps not underestimate small meningiomas, as these could be potential metastasis targets.…”

Brain meningioma incidentally detected on a bone scan: A Case report

“…According to recent studies of the surveillance, epidemiology, and End Results databases, almost 46%-55% of asymptomatic meningiomas were diagnosed incidentally based on radiological imaging without histopathological confirmation [ 8 , 9 ]. Although meningiomas are not particularly dangerous to patients, their commonality and ability to be silent (without signs and symptoms), make them an important entity for physicians to always keep in the back of their minds [10] . The common locations for meningiomas and the lack of specific noninvasive diagnostic tests make it important to be able to differentiate them from the myriad of potentially fatal differentials.…”

Evolving concepts in meningioma management in the era of genomics

“…[7][8][9] Significant growth rate beyond this predicts a more aggressive behavior. 7,8 2586 -Cancer. 2024;130:2586-2600. wileyonlinelibrary.com/journal/cncr © 2024 American Cancer Society.…”

“…[2][3][4][5][6] Benign meningiomas have an average growth rate of 1-1.5 mm per year. [7][8][9] Significant growth rate beyond this predicts a more aggressive behavior. 7,8 2586 -Cancer.…”