Skip to main content

Intracranial meningiomas of atypical (WHO grade II) histology

Journal of Neuro-Oncology volume 99, pages 393–405 (2010)Cite this article

Abstract

Atypical (WHO grade II) meningiomas occupy an intermediate risk group between benign (WHO grade I) and anaplastic (WHO grade III) meningiomas. Although grade II meningiomas have traditionally been recognized in only about 5% of cases, after changes in diagnostic criteria with the current 2007 WHO standards, they now comprise approximately 20–35% of all meningiomas. Given the magnitude of this change, much work is now needed to solidify the adoption of these standards, to render inter-observer and inter-institutional comparisons more uniform, and to more carefully define the incidence of grade II histology. However, it is clear that they carry a several-fold increased risk of recurrence, as well as an increased rate of mortality. We will discuss the definition, diagnosis, and treatment of patients with atypical meningioma; review the current phase II cooperative trials; and draw attention to some questions timely for pre-clinical and clinical research.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Central Brain Tumor Registry in the United States (CBTRUS) (2000) Statistical report: primary brain tumors in the Unites States, 1992–1997. In: Central Brain Tumor Registry of the United States. CBTRUS, Chicago, pp 11–26

  2. DeMonte F, Marmor E, Al-Mefty O (2001) Meningiomas. In: Andrew K, Edward L (eds) Brain Tumors, 2nd edn. Churchill Livingstone, London, pp 719–750

    Google Scholar 

  3. Kuratsu J, Ushio Y (1996) Epidemiological study of primary intracranial tumors: a regional survey in Kumamoto Prefecture in the southern part of Japan. J Neurosurg 84(6):946–950

    CAS  Article  PubMed  Google Scholar 

  4. Kuratsu J, Kochi M, Ushio Y (2000) Incidence and clinical features of asymptomatic meningiomas. J Neurosurg 92(5):766–770

    CAS  Article  PubMed  Google Scholar 

  5. Claus EB, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M, Black PM (2005) Epidemiology of intracranial meningioma. Neurosurgery 57(6):1088–1095 discussion 1088

    Article  PubMed  Google Scholar 

  6. Central Brain Tumor Registry of the United States (2010) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2004–2006. http://www.cbtrus.org/2010-NPCR-SEER/CBTRUS-WEBREPORT-Final-3-2-10.pdf. Accessed Feb 2010

  7. Cushing H, Eisenhardt L (1938) Serial enumeration of meningiomas. In: Meningiomas: their classification, regional behaviour, life history, and surgical end results. Charles C. Thomas, Springfield, pp 56–73

  8. Pearson BE, Markert JM, Fisher WS, Guthrie BL, Fiveash JB, Palmer CA, Riley K (2008) Hitting a moving target: evolution of a treatment paradigm for atypical meningiomas amid changing diagnostic criteria. Neurosurg Focus 24:E3

    Article  PubMed  Google Scholar 

  9. Perry A (2006) Meningiomas. In: McLendon R, Rosenblum M, Bigner DD (eds) Russell & Rubinstein’s pathology of tumors of the nervous system, 7th edn. Hodder Arnold, London, pp 427–474

    Google Scholar 

  10. Louis DN, Scheithauer BW, Budka H (2000) Meningiomas. In: Kleihues P, Cavenee WK (eds) World Health Organization classification of tumours; pathology and genetics of tumours of the nervous system. IARC Press, Lyon, pp 176–184

    Google Scholar 

  11. Perry A, Louis DN, Scheithauer BW, Budka H, von Deimling A (2007) Meningeal tumours. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds) WHO classification of tumours of the central nervous system. IARC, Lyon, pp 164–172

    Google Scholar 

  12. Perry A, Scheithauer BW, Stafford SL et al (1999) Malignancy in meningiomas: a clinicopathologic study of 116 patients. Cancer 85:2046–2056

    CAS  PubMed  Google Scholar 

  13. Ho DMT, Hsu CY, Ting LT et al (2002) Histopathology and MIB-1 labeling index predicted recurrence of meningiomas; a proposal of diagnostic criteria for patients with atypical meningioma. Cancer 94:1538–1547

    Article  PubMed  Google Scholar 

  14. Korshunov A, Shishkina L, Golanov A (2003) Immunohistochemical analysis of p16INK4A, p14ARF, p18INK4C, p21CIP1, p27KIP1 and p73 expression in 271 meningiomas: correlation with tumor grade and clinical outcome. Int J Cancer 104:728–734

    CAS  Article  PubMed  Google Scholar 

  15. Jääskeläinen J (1986) Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients; a multivariate analysis. Surg Neurol 26(5):461–469

    Article  PubMed  Google Scholar 

  16. Milker-Zabel S, Zabel-du Bois A, Huber P, Schlegel W, Debus J (2007) Intensity-modulated radiotherapy for complex-shaped meningioma of the skull base: long-term experience of a single institution. Int J Radiat Oncol Biol Phys 68(3):858–863

    PubMed  Google Scholar 

  17. Willis J, Smith C, Ironside JW, Erridge S, Whittle IR, Everington D (2005) The accuracy of meningioma grading: a 10-year retrospective audit. Neuropathol Appl Neurobiol 31:141–149

    CAS  Article  PubMed  Google Scholar 

  18. Flickinger JC, Kondziolka D, Maitz AH et al (2003) Gamma knife radiosurgery of image-diagnosed intracranial meningioma. Int J Radiat Oncol Biol Phys 56:801–806

    PubMed  Google Scholar 

  19. Ayerbe J, Lobato RD, de la Cruz J, Alday R, Rivas JJ, Gomez PA, Cabrera A (1999) Risk factors predicting recurrence in patients operated on for intracranial meningioma; a multivariate analysis. Acta Neurochir (Wien) 141:921–932

    CAS  Article  Google Scholar 

  20. Rohringer M, Sutherland GR, Louw DF, Sima AA (1989) Incidence and clinicopathological features of meningioma. J Neurosurg 71(5 pt 1):665–672

    Google Scholar 

  21. Schubeus P, Schörner W, Rottacker C, Sander B (1990) Intracranial meningiomas: how frequent are indicative findings in CT and MRI? Neuroradiology 32(6):467–473

    CAS  Article  PubMed  Google Scholar 

  22. Drape JL, Krause D, Tongio J (1992) MRI of aggressive meningiomas. J Neuroradiol 19(1):49–62

    CAS  PubMed  Google Scholar 

  23. Kasuya H, Kubo O, Tanaka M, Amano K, Kato K, Hori T (2006) Clinical and radiological features related to the growth potential of meningioma. Neurosurg Rev 29(4):293–296 discussion 296

    Article  PubMed  Google Scholar 

  24. Nakamura M, Roser F, Michel J, Jacobs C, Samii M (2003) The natural history of incidental meningiomas. Neurosurgery 53(1):62–70 discussion 70

    Article  PubMed  Google Scholar 

  25. Ildan F, Tuna M, Göçer AP et al (1999) Correlation of the relationships of brain–tumor interfaces, magnetic resonance imaging, and angiographic findings to predict cleavage of meningiomas. J Neurosurg 91(3):384–390

    CAS  Article  PubMed  Google Scholar 

  26. Sibtain NA, Howe FA, Saunders DE (2007) The clinical value of proton magnetic resonance spectroscopy in adult brain tumours. Clin Radiol 62:109–119

    CAS  Article  PubMed  Google Scholar 

  27. Demir MK, Iplikcioglu AC, Dincer A, Arslan M, Sav A (2006) Single voxel proton MR spectroscopy findings of typical and atypical intracranial meningiomas. Eur J Radiol 60:48–55

    Article  PubMed  Google Scholar 

  28. Majos C, Alonso J, Aguilera C, Serrallonga M, Perez-Martin J, Acebes JJ, Arus C, Gili J (2003) Proton magnetic resonance spectroscopy ((1)H MRS) of human brain tumours: assessment of differences between tumour types and its applicability in brain tumour categorization. Eur Radiol 13:582–591

    PubMed  Google Scholar 

  29. Buhl R, Nabavi A, Wolff S, Hugo HH, Alfke K, Jansen O, Mehdorn HM (2007) MR spectroscopy in patients with intracranial meningiomas. Neurol Res 29:43–46

    CAS  Article  PubMed  Google Scholar 

  30. Shino A, Nakasu S, Matsuda M, Handa J, Morikawa S, Inubushi T (1999) Noninvasive evaluation of the malignant potential of intracranial meningiomas performed using proton magnetic resonance spectroscopy. J Neurosurg 91:928–934

    CAS  Article  PubMed  Google Scholar 

  31. Qi ZG, Li YX, Wang Y, Geng DY, Li KC, Shen TZ, Chen XR (2008) Lipid signal in evaluation of intracranial meningiomas. Chin Med J (Engl) 121:2415–2419

    CAS  Google Scholar 

  32. Hakyemez B, Yildirim N, Gokalp G, Erdogan C, Parlak M (2006) The contribution of diffusion-weighted MR imaging to distinguishing typical from atypical meningiomas. Neuroradiology 48:513–520

    Article  PubMed  Google Scholar 

  33. Filippi CG, Edgar MA, Ulug AM, Prowda JC, Heier LA, Zimmerman RD (2001) Appearance of meningiomas on diffusion-weighted images: correlating diffusion constants with histopathologic findings. AJNR 22:65–72

    CAS  PubMed  Google Scholar 

  34. Toh CH, Castillo M, Wong AM, Wei KC, Wong HF, Ng SH, Wan YL (2008) Differentiation between classic and atypical meningiomas with use of diffusion tensor imaging. AJNR 29:1630–1635

    Article  PubMed  Google Scholar 

  35. Nagar VA, Ye JR, Ng WH, Chan YH, Hui F, Lee CK, Lim CC (2008) Diffusion-weighted MR imaging: diagnosing atypical or malignant meningiomas and detecting tumor dedifferentiation. AJNR 29:1147–1152

    CAS  Article  PubMed  Google Scholar 

  36. Nakamizo A, Inamura T, Yamaguchi S, Inoha S, Amano T, Ikezaki K, Nishio S, Nakamura Y, Fukui M (2003) Diffusion-weighted imaging predicts postoperative persistence in meningioma patients with peritumoural abnormalities on magnetic resonance imaging. J Clin Neurosci 10:589–593

    Article  PubMed  Google Scholar 

  37. Yamasaki F, Kurisu K, Satoh K, Arita K, Sugiyama K, Ohtaki M, Takaba J, Tominaga A, Hanaya R, Yoshioka H, Hama S, Ito Y, Kajiwara Y, Yahara K, Saito T, Thohar MA (2005) Apparent diffusion coefficient of human brain tumors at MR imaging. Radiology 235:985–991

    Article  PubMed  Google Scholar 

  38. Pavlisa G, Rados M, Pazanin L, Padovan RS, Ozretic D (2008) Characteristics of typical and atypical meningiomas on ADC maps with respect to schwannomas. Clin Imaging 32:22–27

    Article  PubMed  Google Scholar 

  39. Cabada T, Caballero MC, Insausti I, Alvarez de Eulate N, Bacaicoa C, Zazpe I, Tunon T (2009) The role of diffusion-weighted imaging in the evaluation of meningiomas: radio-pathologic correlation. Radiologia 51:411–419

    CAS  Article  PubMed  Google Scholar 

  40. Di Chiro G, Hatazawa J, Katz DA, Rizzoli HV, De Michele DJ (1987) Glucose utilization by intracranial meningiomas as an index of tumor aggressivity and probability of recurrence: a PET study. Radiology 164:521–526

    CAS  PubMed  Google Scholar 

  41. Ogawa T, Inugami A, Hatazawa J, Kanno I, Murakami M, Yasui N, Mineura K, Uemura K (1996) Clinical positron emission tomography for brain tumors: comparison of fludeoxyglucose F 18 and l-methyl-11C-methionine. Am J Neuroradiol 17:345–353

    CAS  PubMed  Google Scholar 

  42. Lippitz B, Cremerius U, Mayfrank L, Bertalanffy H, Raoofi R, Weis J, Bocking A, Bull U, Gilsbach JM (1996) PET-study of intracranial meningiomas: correlation with histopathology, cellularity and proliferation rate. Acta Neurochir Suppl 65:108–111

    CAS  PubMed  Google Scholar 

  43. Cremerius U, Bares R, Weis J, Sabri O, Mull M, Schroder JM, Gilsbach JM, Buell U (1997) Fasting improves discrimination of grade 1 and atypical or malignant meningioma in FDG-PET. J Nucl Med 38:26–30

    CAS  PubMed  Google Scholar 

  44. Ghodsian M, Obrzut SL, Hyde CC, Watts WJ, Schiepers C (2005) Evaluation of metastatic meningioma with 2-deoxy-2-[18F]fluoro-d-glucose PET/CT. Clin Nucl Med 30:717–720

    Article  PubMed  Google Scholar 

  45. Tsuyuguchi N (1997) Kinetic analysis of glucose metabolism by FDG-PET versus proliferation index of Ki-67 in meningiomas–comparison with gliomas. Osaka City Med J 43:209–223

    CAS  PubMed  Google Scholar 

  46. Park Y, Jeon B, Oh H, Lee S, Chun B, Chang H (2006) FDG PET/CT assessment of the biological behaviour of meningiomas. J Korean Neurosurg Soc 40:428–433

    CAS  Google Scholar 

  47. Lee JW, Kang KW, Park SH, Lee SM, Paeng JC, Chung JK, Lee MC, Lee DS (2009) 18F-FDG PET in the assessment of tumor grade and prediction of tumor recurrence in intracranial meningioma. Eur J Nucl Med Mol Imaging 36:1574–1582

    Article  PubMed  Google Scholar 

  48. Iuchi T, Iwadate Y, Namba H, Osato K, Saeki N, Yamaura A, Uchida Y (1999) Glucose and methionine uptake and proliferative activity in meningiomas. Neurol Res 21:640–644

    CAS  PubMed  Google Scholar 

  49. Giovacchini G, Fallanca F, Landoni C, Gianolli L, Picozzi P, Attuati L, Terreni M, Picchio M, Messa C, Fazio (2009) F C-11 choline versus F-18 fluorodeoxyglucose for imaging meningiomas: an initial experience. Clin Nucl Med 34:7–10

    Article  PubMed  Google Scholar 

  50. Weber DC, Vallée JP, Rogers L (2010) New pathology classification, imagery techniques and prospective trials for meningioma: the future looks bright. Curr Opin Neurol (in press)

  51. Cleland J (1864) Description of two tumours adherent to the deep surface of the dura mater. Glasgow Med J 11:148–159

    Google Scholar 

  52. Riemenschneider MJ, Perry A, Reifenberger G (2006) Histological classification and molecular genetics of meningiomas. Lancet Neurol 5(12):1045–1054

    CAS  Article  PubMed  Google Scholar 

  53. Goldsmith B (1998) Meningioma. In: Steven L, Theodore P (eds) Textbook of radiation oncology. WB Saunders, Philadelphia, pp 324–340

    Google Scholar 

  54. Stafford SL, Perry A, Suman VJ et al (1988) Primarily resected meningiomas: outcome, prognostic factors in 581 Mayo Clinic patients, 1978 through 1988. Mayo Clin Proc 73(10):936–942

    Article  Google Scholar 

  55. Wara WM, Bauman GS, Sneed PK (1997) Brain, brainstem, and cerebellum. In: Perez CA, Brady LW, Halperin EC et al (eds) Principles and practice of radiation oncology, 3rd edn. Lippincott Raven, Philadelphia, pp 818–820

    Google Scholar 

  56. Longstreth WT Jr, Dennis LK, McGuire VM, Drangsholt MT, Koepsell TD (1993) Epidemiology of intracranial meningioma. Cancer 72(3):639–648

    Article  PubMed  Google Scholar 

  57. Perry A, Dehner LP (2003) Meningeal tumors of childhood and infancy, an update and literature review. Brain Pathol 13(3):386–408

    Article  PubMed  Google Scholar 

  58. Kurland LT, Schoenberg BS, Annegers JF, Okazaki H, Molgaard CA (1982) The incidence of primary intracranial neoplasms in Rochester, Minnesota, 1935–1977. Ann N Y Acad Sci 381:6–16

    CAS  Article  PubMed  Google Scholar 

  59. Boskos C, Feuvret L, Noel G, Habrand JL, Pommier P, Alapetite C, Mammar H, Ferrand R, Boisserie G, Mazeron JJ (2009) Combined proton and photon conformal radiotherapy for intracranial atypical and malignant meningioma. Int J Radiat Oncol Biol Phys 75(2):399–406

    PubMed  Google Scholar 

  60. Huffmann BC, Reinacher PC, Gilsbach JM (2005) Gamma knife surgery for atypical meningiomas. J Neurosurg 102((suppl)):283–285

    PubMed  Google Scholar 

  61. Aghi MK, Carter BS, Cosgrove GR, Ojemann RG, Amin-Hanjani S, Martuza RL, Curry WT, Barker FG (2009) Long-term recurrence rates of atypical meningiomas after gross total resection with or without post-operative radiation. Neurosurgery 64:6–56

    Article  Google Scholar 

  62. Park H, Kim I, Jung H (2009) Atypical meningioma: outcome, prognostic factors. Int J Radiat Oncol Biol Phys 75(3):S238 (abst)

    Google Scholar 

  63. Milosevic MF, Frost PJ, Laperriere NJ, Wong CS, Simpson WJ (1996) Radiotherapy for atypical or malignant intracranial meningioma. Int J Radiat Oncol Biol Phys 34(4):817–822

    CAS  PubMed  Google Scholar 

  64. Goyal LK, Suh JH, Mohan DS, Prayson RA, Lee J, Barnett GH (2000) Local control and overall survival in atypical meningioma: a retrospective study. Int J Radiat Oncol Biol Phys 46(1):57–61

    CAS  Article  PubMed  Google Scholar 

  65. Kano H, Takahashi JA, Katsuki T, Araki N, Oya N, Hiraoka M, Hashimoto N (2007) Stereotactic radiosurgery for atypical and anaplastic meningiomas. J Neurooncol 84:41–47

    Article  PubMed  Google Scholar 

  66. Hug EB, Devries A, Thornton AF, Munzenrider JE, Pardo S, Hedley-Whyte ET, Bussiere MR, Ojemann R (2000) Management of atypical and malignant meningiomas: role of high-dose, 3D-conformal radiation therapy. J Neurooncol 48:151–160

    CAS  Article  PubMed  Google Scholar 

  67. Rogers L, Mehta M (2007) Role of radiation therapy in treating intracranial meningiomas. Neurosurg Focus 23(4):E4

    Article  PubMed  Google Scholar 

  68. Mahmood A, Caccamo DV, Tomacek FJ, Malik GM (1993) Atypical and malignant meningiomas: a clinicopathological review. Neurosurgery 33(6):955–963

    CAS  Article  PubMed  Google Scholar 

  69. Perry A (2004) Unmasking the secrets of meningioma: a slow but rewarding journey. Surg Neurol 61(2):171–173

    Article  PubMed  Google Scholar 

  70. Palma L, Celli P, Franco C, Cervoni L, Cantore G (1997) Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases. J Neurosurg 86(5):793–800

    CAS  Article  PubMed  Google Scholar 

  71. Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22–39

    CAS  Article  PubMed  Google Scholar 

  72. Condra KS, Buatti JM, Mendenhall WM, Friedman WA, Marcus RB, Rhoton AL (1997) Benign meningiomas: primary treatment selection affects survival. Int J Radiat Oncol Biol Phys 39:427–436

    CAS  PubMed  Google Scholar 

  73. Kinjo T, Al-Mefty O, Kanaan I (1994) Grade zero removal of supratentorial convexity meningiomas. Neurosurgery 33(3):394–399

    Article  Google Scholar 

  74. Winkler C, Dornfeld S, Schwarz R et al (1998) The results of radiotherapy in meningiomas with a high risk of recurrence, a retrospective analysis. Strahlenther Onkol 174:624–628

    CAS  Article  PubMed  Google Scholar 

  75. Attia A, Chan M, Seif D, Russel B, Bourland JD, Deguzman A, Ellis T, McMullen K, Tatter S, Shaw EG (2009) Treatment of atypical meningiomas with GammaKnife Radiosurgery: the role of conformality index and margin dose. Int J Radiat Oncol Biol Phys 75(3):S226 (abst)

    Google Scholar 

  76. Skeie BS, Enger PO, Skeie GO, Thorsen F, Pedersen PH (2010) Gamma Knife Surgery of meningiomas involving the cavernous sinus: long-term follow-up of 100 patients. Neurosurgery 66:661–669

    Article  PubMed  Google Scholar 

  77. Coke C, Corn B, Werner-Wasik M, Xie Y, Curran WJ (1998) Atypical and malignant meningiomas: an outcome report of 17 cases. J Neurooncol 29:65–70

    Article  Google Scholar 

  78. Harris AE, Lee JYK, Omalu B, Flickinger JC, Kondziolka D, Lunsford LD (2003) The effect of radiosurgery during management of aggressive meningiomas. Surg Neurol 60(4):298–305

    Article  PubMed  Google Scholar 

  79. Stafford S, Pollock B, Foote R, Link MJ, Gorman DA, Schomberg PJ, Leavitt JA (2001) Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients. Neurosurgery 49:1029–1038

    CAS  Article  PubMed  Google Scholar 

  80. Hoffmann W, Mühleisen H, Hess CF, Kortmann RD, Schmidt B, Grote EH, Bamberg M (1995) Atypical and anaplastic meningiomas – does the new WHO classification of brain tumors affect the indication for post-operative irradiation. Acta Neurochir 135:171–178

    CAS  Article  Google Scholar 

  81. Katz TS, Amdur RJ, Yachnis AT, Mendenhall WM, Morris CG (2005) Pushing the limits of radiotherapy for atypical and malignant meningioma. Am J Clin Oncol 28(1):70–74

    Article  PubMed  Google Scholar 

  82. Vernimmen FJ, Harris JK, Wilson JA, Melvill R, Smit BJ, Slabbert JP (2001) Stereotactic proton beam therapy of skull base meningiomas. Int J Radiat Oncol Biol Phys 49(1):99–105

    CAS  PubMed  Google Scholar 

  83. Girvigian MR, Chen JCT, Rahimian J, Miller MJ, Tome M (2008) Comparison of early complications for patients with convexity and parasagittal meningiomas treated with either stereotactic radiosurgery of fractionated stereotactic radiotherapy. Neurosurgery 62:A19–A28 (May 2008 suppl)

    Article  PubMed  Google Scholar 

  84. Lominska CE, Unger K, Jean WC, Chanyasulkit J, Collins B, Collins S, Gagnon G (2009) Multisession stereotactic radiosurgery for meningioma results in low rates of post-treatment edema. Int J Radiat Oncol Biol Phys 75(3):S242

    Google Scholar 

  85. Columbo F, Casentini Cavedon C, Scalchi P, Cora S, Francescon P (2009) Cyberknife radiosurgery for benign meningiomas: short-term results in 199 patients. Neurosurgery 64(2):A7–A13 (February 2009 suppl)

    Article  Google Scholar 

Download references

Author information

Affiliations

  1. GammaWest Cancer Services, Salt Lake City, UT, USA

    Leland Rogers

  2. Neuro-Oncology, M.D. Anderson, Houston, TX, USA

    Mark Gilbert

  3. Brain Tumor & NeuroOncology Ctr, Cleveland Clinic - Neurological Institute, 9500 Euclid Avenue - ND40, Cleveland, OH, 44195, USA

    Michael A. Vogelbaum

Authors
  1. Leland Rogers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark Gilbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael A. Vogelbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leland Rogers.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Rogers, L., Gilbert, M. & Vogelbaum, M.A. Intracranial meningiomas of atypical (WHO grade II) histology. J Neurooncol 99, 393–405 (2010). https://doi.org/10.1007/s11060-010-0343-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-010-0343-1

Keywords

  • Meningiomas
  • Atypical
  • WHO grade II