Acta Neurochirurgica

, Volume 160, Issue 8, pp 1547–1553 | Cite as

Non-operative meningiomas: long-term follow-up of 136 patients

  • Rossana RomaniEmail author
  • George Ryan
  • Christian Benner
  • Jonathan Pollock
Original Article - Brain Tumors



Improving access to neuroradiology investigations has led to an increased rate of diagnosis of incidental meningiomas.


A cohort of 136 incidental meningioma patients collected by a single neurosurgeon in a single neurosurgical centre is retrospectively analysed between 2002 and 2016. Demographic data, imaging and clinical features are presented. The radiological factors associated with meningiomas progression are also presented.


The mean age at diagnosis was 65 (range, 33–94) years. Univariate analysis showed oedema was most strongly correlated with progression (p = 0.010) followed by hyperintensity in T2-weighted (T2W) MRI (p = 0.029) and in Flair-T2W MRI (p = 0.017). Isointensity in Flair-T2W MRI (0.004) was most strongly correlated with non-progression of the meningioma followed by calcification (p = 0.007), older age (p = 0.087), hypointensity in Flair-T2W MRI (p = 0.014) sequences and in T2W MRI (p = 0.096). In multivariate analysis, the strongest radiological factor predictive of progression was peritumoural oedema (p = 0.016) and that of non-progression was calcification (p = 0.002). At the end of the median follow-up (FU) of 43 (range, 4–150) months, 109 (80%) patients remained clinically stable, 13 (10%) became symptomatic and 14 (10%) showed clinical and radiological progression.


One hundred and nine (80%) patients remained stable at the end of FU. Peritumoural oedema was predictive of meningiomas progression. Further prospective study is needed to identify the combination of factors which can predict the meningioma progression for an early surgery or early discharge.


Calcification Incidental Magnetic resonance imaging Meningioma Natural history Oedema Progression 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures of this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


  1. 1.
    Andersen L, Friis S, Hallas J, Ravn P, Schroder HD, Gaist D (2013) Hormone replacement therapy increases the risk of cranial meningioma. Eur J Cancer.
  2. 2.
    Bindal R, Goodman JM, Kawasaki A, Purvin V, Kuzma B (2003) The natural history of untreated skull base meningiomas. Surg NeurolGoogle Scholar
  3. 3.
    Bos D, Poels MM, Adams HH, Akoudad S, Cremers LG, Zonneveld HI, Hoogendam YY, Verhaaren BF, Verlinden VJ, Verbruggen JG, Peymani A, Hofman A, Krestin GP, Vincent AJ, Feelders RA, Koudstaal PJ, van der Lugt A, Ikram MA, Vernooij MW (2016) Prevalence, clinical management, and natural course of incidental findings on brain MR images: the population-based Rotterdam scan study. Radiology.
  4. 4.
    Claus EB, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M, Black PM (2005) Epidemiology of intracranial meningioma. NeurosurgeryGoogle Scholar
  5. 5.
    Fan ZX, Shen J, Wu YY, Yu H, Zhu Y, Zhan RY (2013) Hormone replacement therapy and risk of meningioma in women: a meta-analysis. Cancer Causes Control.
  6. 6.
    Firsching RP, Fischer A, Peters R, Thun F, Klug N (1990) Growth rate of incidental meningiomas. J Neurosurg.
  7. 7.
    Go RS, Taylor BV, Kimmel DW (1998) The natural history of asymptomatic meningiomas in Olmsted County, Minnesota. Neurology. 9855530Google Scholar
  8. 8.
    Hashiba T, Hashimoto N, Izumoto S, Suzuki T, Kagawa N, Maruno M, Kato A, Yoshimine T (2009) Serial volumetric assessment of the natural history and growth pattern of incidentally discovered meningiomas. J Neurosurg.
  9. 9.
    Hashiba T, Hashimoto N, Maruno M, Izumoto S, Suzuki T, Kagawa N, Yoshimine T (2006) Scoring radiologic characteristics to predict proliferative potential in meningiomas. Brain Tumor Pathol.
  10. 10.
    Herscovici Z, Rappaport Z, Sulkes J, Danaila L, Rubin G (2004) Natural history of conservatively treated meningiomas. NeurologyGoogle Scholar
  11. 11.
    Huang MC, van Loveren HR (2001) Anatomy and biology of the leptomeninges. In: DeMonte F, McDermott MW, Al-Mefty O (eds) Al-Mefty’s Meningiomas, second edn. Thieme, pp 25–34Google Scholar
  12. 12.
    Jadid KD, Feychting M, Hoijer J, Hylin S, Kihlstrom L, Mathiesen T (2015) Long-term follow-up of incidentally discovered meningiomas. Acta Neurochir (Wien).
  13. 13.
    Jay JR, MacLaughlin DT, Riley KR, Martuza RL (1985) Modulation of meningioma cell growth by sex steroid hormones in vitro. J Neurosurg.
  14. 14.
    Karnofsky DA (1948) Chemotherapy of neoplastic disease; methods of approach. N Engl J Med.
  15. 15.
    Kuratsu J, Kochi M, Ushio Y (2000) Incidence and clinical features of asymptomatic meningiomas. J Neurosurg.
  16. 16.
    Lee EJ, Kim JH, Park ES, Kim YH, Lee JK, Hong SH, Cho YH, Kim CJ (2017) A novel weighted scoring system for estimating the risk of rapid growth in untreated intracranial meningiomas. J Neurosurg.
  17. 17.
    Morrison AL, Rushing E (2001) Pathology of meningiomas. In: DeMonte F, McDermott MW, Al-Mefty O (eds) Al-Mefty’s Meningiomas, Second edn. Thieme, pp 40–50Google Scholar
  18. 18.
    Nakamura M, Roser F, Michel J, Jacobs C, Samii M (2003) The natural history of incidental meningiomas. Neurosurgery. 12823874Google Scholar
  19. 19.
    Nakasu S, Fukami T, Nakajima M, Watanabe K, Ichikawa M, Matsuda M (2005) Growth pattern changes of meningiomas: long-term analysis. Neurosurgery. 15854242Google Scholar
  20. 20.
    Niiro M, Yatsushiro K, Nakamura K, Kawahara Y, Kuratsu J (2000) Natural history of elderly patients with asymptomatic meningiomas. J Neurol Neurosurg Psychiatry. 1760589Google Scholar
  21. 21.
    Olivero WC, Lister JR, Elwood PW (1995) The natural history and growth rate of asymptomatic meningiomas: a review of 60 patients. J Neurosurg.
  22. 22.
    Oya S, Sade B, Lee JH (2011) Benefits and limitations of diameter measurement in the conservative management of meningiomas. Surg Neurol Int.
  23. 23.
    Romani R, Laakso A, Kangasniemi M, Lehecka M, Hernesniemi J (2011) Lateral supraorbital approach applied to anterior clinoidal meningiomas: experience with 73 consecutive patients. Neurosurgery.
  24. 24.
    Romani R, Laakso A, Kangasniemi M, Niemela M, Hernesniemi J (2012) Lateral supraorbital approach applied to tuberculum sellae meningiomas: experience with 52 consecutive patients. Neurosurgery.
  25. 25.
    Sahm F, Schrimpf D, Stichel D, Jones DTW, Hielscher T, Schefzyk S, Okonechnikov K, Koelsche C, Reuss DE, Capper D, Sturm D, Wirsching HG, Berghoff AS, Baumgarten P, Kratz A, Huang K, Wefers AK, Hovestadt V, Sill M, Ellis HP, Kurian KM, Okuducu AF, Jungk C, Drueschler K, Schick M, Bewerunge-Hudler M, Mawrin C, Seiz-Rosenhagen M, Ketter R, Simon M, Westphal M, Lamszus K, Becker A, Koch A, Schittenhelm J, Rushing EJ, Collins VP, Brehmer S, Chavez L, Platten M, Hänggi D, Unterberg A, Paulus W, Wick W, Pfister SM, Mittelbronn M, Preusser M, Herold-Mende C, Weller M, von Deimling A (2017) DNA methylation-based classification and grading system for meningioma: a multicentre, retrospective analysis. Lancet Oncol.
  26. 26.
    Yano S, Kuratsu JI (2001) Natural course of untreated meningiomas. In: DeMonte F, McDermott MW, Al-Mefty O (eds) Al-Mefty’s Meningiomas, second edn. Thieme, pp 63–67Google Scholar
  27. 27.
    Yano S, Kuratsu J, Kumamoto Brain Tumor Research Group (2006) Indications for surgery in patients with asymptomatic meningiomas based on an extensive experience. J Neurosurg.
  28. 28.
    Yoneoka Y, Fujii Y, Tanaka R (2000) Growth of incidental meningiomas. Acta Neurochir (Wien). 10898357Google Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, Charing Cross HospitalImperial College NHS TrustLondonUK
  2. 2.Department of Neurosurgery, Essex Neuroscience CentreQueen’s HospitalRomfordUK
  3. 3.Department of Mathematics and StatisticsUniversity of HelsinkiHelsinkiFinland

Personalised recommendations