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Meningiomas and Meningeal Tumors

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Oncology of CNS Tumors

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Abstract

Meningiomas are a major group of intracranial neoplasms. According to the WHO classification, they are subdivided into three grades with increasing anaplasia, grade I being the commonest (about 80%) followed by the atypical grade II tumors (about 20%) and the rare anaplastic, WHO grade III (1–3%) type. Meningiomas have a wide spectrum of presenting symptoms, depending on the site of the skull where they originate. Likewise, the neuroradiological appearance is highly variable but a uniform feature of contrast enhancement. Signs of calcification are frequent, especially in slowly growing lesions and cystic variants exist. Meningiomas may be surrounded by massive edema, resulting from venous compression or from secreted cytokines. Treatment is multidisciplinary with an attempt at resection as primary option but also combinations of partial removal and ensuing radiotherapy for some skull base lesions. For selected cases, especially meningiomas of the cavernous sinus, primary conformal stereotactic radiotherapy is an option. There is no targeted medical therapy for meningiomas. Meningiomas can recur, and there are patients with a “chronic meningioma disease” who will accumulate genetic aberrations leading to increasing anaplasia. The prognosis is generally excellent when a gross total resection including the original matrix is possible but extremely bad for recurrent anaplastic tumors. Encasement of skull base structures such as the carotids or the basilar artery, the optic nerves or caudal cranial nerves, as well as superficial brain invasion in occipital falcine meningiomas may be prognostically unfavorable for function and survival even in grade I lesions rendering the distinction between benign and malignant lesions irrelevant for individual cases. The spectrum of clinical presentations and the differential therapeutic approaches is outlined in detail in this chapter.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Hamburg, University Hospital Eppendorf, Hamburg, Hamburg, Germany

    Manfred Westphal

  2. Department of Neurosurgery, University of Hamburg, Hamburg, Germany

    Katrin Lamszus

  3. Department of Neurosurgery, University Hospital Ludwig Maximilian University Munich, Munich, Germany

    Jörg-Christian Tonn

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  1. Manfred Westphal
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  2. Katrin Lamszus
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  3. Jörg-Christian Tonn
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Correspondence to Manfred Westphal .

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Editors and Affiliations

  1. Department of Neurosurgery, University of Munich Department of Neurosurgery, Munich, Germany

    Jörg-Christian Tonn

  2. Dana-Farber Cancer Institute Center, Harvard University, Boston, USA

    David A. Reardon

  3. SickKids Hospital, University of Toronto, Toronto, ON, Canada

    James T. Rutka

  4. Department of Neurosurgery, University of Hamburg, Hamburg, Germany

    Manfred Westphal

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Westphal, M., Lamszus, K., Tonn, JC. (2019). Meningiomas and Meningeal Tumors. In: Tonn, JC., Reardon, D., Rutka, J., Westphal, M. (eds) Oncology of CNS Tumors. Springer, Cham. https://doi.org/10.1007/978-3-030-04152-6_8

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