Advertisement

Meningioma

  • Ali-Reza Fathi
  • Ulrich Roelcke
Neuro-Oncology (LE Abrey, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Neuro-Oncology

Abstract

Meningiomas represent the most common primary brain tumor and comprise 3 World Health Organization (WHO) grades, the most frequent being WHO grade I (90 %). Surgery is mandatory to establish the diagnosis and to remove the tumor; however, complete resection can be achieved in only <50 % of patients. Depending on the extent of resection, tumor location and the WHO grade radiation therapy can be applied. The issue of systemic treatment such as chemotherapy or targeted therapy (eg, somatostatin receptors, antiangiogenic agents) is yet not solved, particularly as current data are derived from small uncontrolled series in patients with long-standing disease and after several pretreatments. A more thorough understanding of molecular genetics, signaling pathways and prognostic factors in meningiomas should lead to the design of studies which stratify according to these factors. These studies have to be conducted in newly diagnosed patients after incomplete resection and in tumors of WHO grade II and III.

Keywords

Meningioma Benign brain tumor Skull base Neurofibromatosis Diagnosis Imaging Pathology Molecular genetics Neurosurgery Surgery Radiation therapy Radiosurgery Somatostatin receptors Chemotherapy Targeted therapy 

Notes

Disclosure

Ali-Reza Fathi declares no conflict of interest. Ulrich Roelcke declares no conflict of interest.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Kotecha RS, Pascoe EM, Rushing EJ, Rorke-Adams LB, Zwerdling T, Gao X, et al. Meningiomas in children and adolescents: a meta-analysis of individual patient data. Lancet Oncol. 2011;12(13):1229–39. Comprehensive review on epidemiologic and outcome data for meningiomas in children and adults.PubMedCrossRefGoogle Scholar
  2. 2.
    Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. J Neurooncol. 2010;99(3):307–14.PubMedCrossRefGoogle Scholar
  3. 3.
    Oya S, Kim SH, Sade B, Lee JH. The natural history of intracranial meningiomas. J Neurosurg. 2011;114(5):1250–6.PubMedGoogle Scholar
  4. 4.
    Nakasu S, Hirano A, Shimura T, Llena JF. Incidental meningiomas in autopsy study. Surg Neurol. 1987;27(4):319–22.PubMedCrossRefGoogle Scholar
  5. 5.
    Zeidman LA, Ankenbrandt WJ, Du H, Paleologos N, Vick NA. Growth rate of non-operated meningiomas. J Neurol. 2008;255(6):891–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Greenberg M. Handbook of Neurosurgery. 6th ed. New York: Thieme; 2006.Google Scholar
  7. 7.
    Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114(2):97–109.PubMedCrossRefGoogle Scholar
  8. 8.
    Artlich A, Schmidt D. Immunohistochemical profile of meningiomas and their histological subtypes. Hum Pathol. 1990;21(8):843–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Hottinger AF, Khakoo Y. Neurooncology of familial cancer syndromes. J Child Neurol. 2009;24(12):1526–35.PubMedCrossRefGoogle Scholar
  10. 10.
    Zhou L, Hanemann CO. Merlin, a multi-suppressor from cell membrane to the nucleus. FEBS Lett. 2012;586(10):1403–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Wang X, Gong Y, Wang D, Xie Q, Zheng M, Zhou Y, et al. Analysis of gene expression profiling in meningioma: deregulated signaling pathways associated with meningioma and egfl6 overexpression in benign meningioma tissue and serum. PLoS One. 2012;7(12):e52707.PubMedCrossRefGoogle Scholar
  12. 12.
    Ragel BT, Jensen RL. Aberrant signaling pathways in meningiomas. J Neurooncol. 2010;99(3):315–24.PubMedCrossRefGoogle Scholar
  13. 13.
    Mawrin C, Perry A. Pathological classification and molecular genetics of meningiomas. J Neurooncol. 2010;99(3):379–91.PubMedCrossRefGoogle Scholar
  14. 14.
    Gabeau-Lacet D, Aghi M, Betensky RA, Barker FG, Loeffler JS, Louis DN. Bone involvement predicts poor outcome in atypical meningioma. J Neurosurg. 2009;111(3):464–71.PubMedCrossRefGoogle Scholar
  15. 15.
    Pravdenkova S, Al-Mefty O, Sawyer J, Husain M. Progesterone and estrogen receptors: opposing prognostic indicators in meningiomas. J Neurosurg. 2006;105(2):163–73.PubMedCrossRefGoogle Scholar
  16. 16.
    Hasseleid BF, Meling TR, Ronning P, Scheie D, Helseth E. Surgery for convexity meningioma: Simpson Grade I resection as the goal. J Neurosurg. 2012;117(6):999–1006.PubMedCrossRefGoogle Scholar
  17. 17.
    Black PM, Morokoff AP, Zauberman J. Surgery for extra-axial tumors of the cerebral convexity and midline. Neurosurgery. 2008;62(6 Suppl 3):1115–21. discussion 21–3.PubMedGoogle Scholar
  18. 18.
    Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW. Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. J Neurol Neurosurg Psychiatry. 2008;79(5):574–80.PubMedCrossRefGoogle Scholar
  19. 19.
    Jaaskelainen J. Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis. Surg Neurol. 1986;26(5):461–9.PubMedCrossRefGoogle Scholar
  20. 20.
    • Tseng KY, Chung MH, Sytwu HK, Lee HM, Chen KY, Chang C, et al. Osteopontin expression is a valuable marker for prediction of short-term recurrence in WHO grade I benign meningiomas. J Neurooncol. 2010;100(2):217–23. Osteopontin represents an integrin-binding protein and constitutes a prognostic factor which relates to progression-free survival within the histopathologic ‘entity’ of WHO I meningiomas.PubMedCrossRefGoogle Scholar
  21. 21.
    Saloner D, Uzelac A, Hetts S, Martin A, Dillon W. Modern meningioma imaging techniques. J Neurooncol. 2010;99(3):333–40.PubMedCrossRefGoogle Scholar
  22. 22.
    Omay SB, Barnett GH. Surgical navigation for meningioma surgery. J Neurooncol. 2010;99(3):357–64.PubMedCrossRefGoogle Scholar
  23. 23.
    Hoover JM, Morris JM, Meyer FB. Use of preoperative magnetic resonance imaging T1 and T2 sequences to determine intraoperative meningioma consistency. Surg Neurol Int. 2011;2:142.PubMedCrossRefGoogle Scholar
  24. 24.
    Osawa T, Tosaka M, Nagaishi M, Yoshimoto Y. Factors affecting peritumoral brain edema in meningioma: special histological subtypes with prominently extensive edema. J Neurooncol. 2012;111:49–57.PubMedCrossRefGoogle Scholar
  25. 25.
    Regelsberger J, Hagel C, Emami P, Ries T, Heese O, Westphal M. Secretory meningiomas: a benign subgroup causing life-threatening complications. Neuro Oncol. 2009;11(6):819–24.PubMedCrossRefGoogle Scholar
  26. 26.
    Qi ST, Liu Y, Pan J, Chotai S, Fang LX. A radiopathological classification of dural tail sign of meningiomas. J Neurosurg. 2012;117(4):645–53.PubMedCrossRefGoogle Scholar
  27. 27.
    Jolapara M, Kesavadas C, Radhakrishnan VV, Thomas B, Gupta AK, Bodhey N, et al. Role of diffusion tensor imaging in differentiating subtypes of meningiomas. J Neuroradiol. 2010;37(5):277–83.PubMedCrossRefGoogle Scholar
  28. 28.
    Chang V, Narang J, Schultz L, Issawi A, Jain R, Rock J, et al. Computeraided volumetric analysis as a sensitive tool for the management of incidental meningiomas. Acta Neurochir (Wien). 2012;154(4):589–97. discussion 97.CrossRefGoogle Scholar
  29. 29.
    Fathi AR, Marbacher S, Lukes A. Cost-effective patient-specific intraoperative molded cranioplasty. J Craniofac Surg. 2008;19(3):777–81.PubMedCrossRefGoogle Scholar
  30. 30.
    Rubin G, Herscovici Z, Laviv Y, Jackson S, Rappaport ZH. Outcome of untreated meningiomas. Isr Med Assoc J. 2011;13(3):157–60.PubMedGoogle Scholar
  31. 31.
    Quinones-Hinojosa A, Kaprealian T, Chaichana KL, Sanai N, Parsa AT, Berger MS, et al. Pre-operative factors affecting resectability of giant intracranial meningiomas. Can J Neurol Sci. 2009;36(5):623–30.PubMedGoogle Scholar
  32. 32.
    Carli DF, Sluzewski M, Beute GN, van Rooij WJ. Complications of particle embolization of meningiomas: frequency, risk factors, and outcome. AJNR Am J Neuroradiol. 2010;31(1):152–4.PubMedCrossRefGoogle Scholar
  33. 33.
    Afshar-Oromieh A, Giesel FL, Linhart HG, Haberkorn U, Haufe S, Combs SE, et al. Detection of cranial meningiomas: comparison of (6)(8)Ga-DOTATOC PET/CT and contrast-enhanced MRI. Eur J Nucl Med Mol Imaging. 2012;39(9):1409–15.PubMedCrossRefGoogle Scholar
  34. 34.
    Gehler B, Paulsen F, Oksuz MO, Hauser TK, Eschmann SM, Bares R, et al. [68Ga]-DOTATOC-PET/CT for meningioma IMRT treatment planning. Radiat Oncol. 2009;4:56.PubMedCrossRefGoogle Scholar
  35. 35.
    Thorwarth D, Muller AC, Pfannenberg C, Beyer T. Combined PET/MR imaging using (68)Ga-DOTATOC for radiotherapy treatment planning in meningioma patients. Recent Results Cancer Res. 2012;194:425–39.CrossRefGoogle Scholar
  36. 36.
    Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, McDermott MW, Parsa AT. Treatment decision making based on the published natural history and growth rate of small meningiomas. J Neurosurg. 2010;113(5):1036–42.PubMedCrossRefGoogle Scholar
  37. 37.
    Yano S, Kuratsu J. Indications for surgery in patients with asymptomatic meningiomas based on an extensive experience. J Neurosurg. 2006;105(4):538–43.PubMedCrossRefGoogle Scholar
  38. 38.
    Chamoun R, Krisht KM, Couldwell WT. Incidental meningiomas. Neurosurg Focus. 2011;31(6):E19.PubMedCrossRefGoogle Scholar
  39. 39.
    Dirks MS, Butman JA, Kim HJ, Wu T, Morgan K, Tran AP, et al. Long-term natural history of neurofibromatosis Type 2-associated intracranial tumors. J Neurosurg. 2012;117(1):109–17.PubMedCrossRefGoogle Scholar
  40. 40.
    Goutagny S, Bah AB, Henin D, Parfait B, Grayeli AB, Sterkers O, et al. Longterm follow-up of 287 meningiomas in neurofibromatosis type 2 patients: clinical, radiological, and molecular features. Neuro Oncol. 2012;14(8):1090–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Adachi K, Kawase T, Yoshida K, Yazaki T, Onozuka S. ABC Surgical Risk Scale for skull base meningioma: a new scoring system for predicting the extent of tumor removal and neurological outcome. Clinical article. J Neurosurg. 2009;111(5):1053–61.PubMedCrossRefGoogle Scholar
  42. 42.
    Gerlach R, Raabe A, Scharrer I, Meixensberger J, Seifert V. Post-operative hematoma after surgery for intracranial meningiomas: causes, avoidable risk factors and clinical outcome. Neurol Res. 2004;26(1):61–6.PubMedCrossRefGoogle Scholar
  43. 43.
    • Strassner C, Buhl R, Mehdorn HM. Recurrence of intracranial meningiomas: did better methods of diagnosis and surgical treatment change the outcome in the last 30 years? Neurol Res. 2009;31(5):478–82. With better operating modalities and additional treatment with radiation and gamma knife, the mortality decreased significantly from 12 % to 3 % and the outcome of the patients is still improving, so that even elderly patients can undergo surgical treatment with minor risks.PubMedCrossRefGoogle Scholar
  44. 44.
    Al-Mefty O, Holoubi A, Rifai A, Fox JL. Microsurgical removal of suprasellar meningiomas. Neurosurgery. 1985;16(3):364–72.PubMedCrossRefGoogle Scholar
  45. 45.
    Kim EH, Cho JM, Chang JH, Kim SH, Lee KS. Application of intraoperative indocyanine green videoangiography to brain tumor surgery. Acta Neurochir (Wien). 2011;153(7):1487–95. discussion 94–5.CrossRefGoogle Scholar
  46. 46.
    Coluccia D, Fandino J, Fujioka M, Cordovi S, Muroi C, Landolt H. Intraoperative 5-aminolevulinic-acid-induced fluorescence in meningiomas. Acta Neurochir (Wien). 2010;152(10):1711–9.CrossRefGoogle Scholar
  47. 47.
    Bekelis K, Valdes PA, Erkmen K, Leblond F, Kim A, Wilson BC, et al. Quantitative and qualitative 5-aminolevulinic acid-induced protoporphyrin IX fluorescence in skull base meningiomas. Neurosurg Focus. 2011;30(5):E8.PubMedGoogle Scholar
  48. 48.
    Soleman J, Fathi AR, Marbacher S, Fandino J. The role of intraoperative magnetic resonance imaging in complex meningioma surgery magnetic resonance imaging. Magnetic Resonance Imaging. 2012;In Press [accepted].Google Scholar
  49. 49.
    Solheim O, Selbekk T, Lindseth F, Unsgard G. Navigated resection of giant intracranial meningiomas based on intraoperative 3D ultrasound. Acta Neurochir (Wien). 2009;151(9):1143–51.CrossRefGoogle Scholar
  50. 50.
    Marbacher S, Coluccia D, Fathi AR, Andereggen L, Beck J, Fandino J. Intraoperative patient-specific reconstruction of partial bone flap defects after convexity meningioma resection. World Neurosurg. 2013;79(1):124–30.PubMedCrossRefGoogle Scholar
  51. 51.
    Dehdashti AR, Ganna A, Witterick I, Gentili F. Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions: indications and limitations. Neurosurgery. 2009;64(4):677–87. discussion 87–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Fatemi N, Dusick JR, de Paiva Neto MA, Malkasian D, Kelly DF. Endonasal versus supraorbital keyhole removal of craniopharyngiomas and tuberculum sellae meningiomas. Neurosurgery. 2009;64(5 Suppl 2):269–84. discussion 84–6.PubMedGoogle Scholar
  53. 53.
    Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH. Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas. World Neurosurg. 2012;77(5–6):713–24.PubMedCrossRefGoogle Scholar
  54. 54.
    Schroeder HW, Hickmann AK, Baldauf J. Endoscope-assisted microsurgical resection of skull base meningiomas. Neurosurg Rev. 2011;34(4):441–55.PubMedCrossRefGoogle Scholar
  55. 55.
    Bledsoe JM, Link MJ, Stafford SL, Park PJ, Pollock BE. Radiosurgery for large-volume (> 10 cm3) benign meningiomas. J Neurosurg. 2010;112(5):951–6.PubMedCrossRefGoogle Scholar
  56. 56.
    Bloch O, Kaur G, Jian BJ, Parsa AT, Barani IJ. Stereotactic radiosurgery for benign meningiomas. J Neurooncol. 2012;107(1):13–20.PubMedCrossRefGoogle Scholar
  57. 57.
    Flannery TJ, Kano H, Lunsford LD, Sirin S, Tormenti M, Niranjan A, et al. Long-term control of petroclival meningiomas through radiosurgery. J Neurosurg. 2010;112(5):957–64.PubMedCrossRefGoogle Scholar
  58. 58.
    Astner ST, Theodorou M, Dobrei-Ciuchendea M, Auer F, Kopp C, Molls M, et al. Tumor shrinkage assessed by volumetric MRI in the long-term follow-up after stereotactic radiotherapy of meningiomas. Strahlenther Onkol. 2010;186(8):423–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Kondziolka D, Madhok R, Lunsford LD, Mathieu D, Martin JJ, Niranjan A, et al. Stereotactic radiosurgery for convexity meningiomas. J Neurosurg. 2009;111(3):458–63.PubMedCrossRefGoogle Scholar
  60. 60.
    Kondziolka D, Mathieu D, Lunsford LD, Martin JJ, Madhok R, Niranjan A, et al. Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery. 2008;62(1):53–8. discussion 8–60.PubMedCrossRefGoogle Scholar
  61. 61.
    Stessin AM, Schwartz A, Judanin G, Pannullo SC, Boockvar JA, Schwartz TH, et al. Does adjuvant external-beam radiotherapy improve outcomes for nonbenign meningiomas? A Surveillance, Epidemiology, and End Results (SEER)-based analysis. J Neurosurg. 2012;117(4):669–75.PubMedCrossRefGoogle Scholar
  62. 62.
    Askoxylakis V, Zabel-du Bois A, Schlegel W, Debus J, Huber P, Milker-Zabel S. Patterns of failure after stereotactic radiotherapy of intracranial meningioma. J Neurooncol. 2010;98(3):367–72.PubMedCrossRefGoogle Scholar
  63. 63.
    Attia A, Chan MD, Mott RT, Russell GB, Seif D, Daniel Bourland J, et al. Patterns of failure after treatment of atypical meningioma with gamma knife radiosurgery. J Neurooncol. 2012;108(1):179–85.PubMedCrossRefGoogle Scholar
  64. 64.
    •• Santacroce A, Walier M, Regis J, Liscak R, Motti E, Lindquist C, et al. Longterm tumor control of benign intracranial meningiomas after radiosurgery in a series of 4565 patients. Neurosurgery. 2012;70(1):32–9. discussion 9. One of the largest series with gamma knife treatment of benign meningiomas (5300 treated tumors) reported on 5- and 10-year progression-free survival rates of 95.2 % and 88.6 %, respectively.PubMedCrossRefGoogle Scholar
  65. 65.
    Henze M, Dimitrakopoulou-Strauss A, Milker-Zabel S, Schuhmacher J, Strauss LG, Doll J, et al. Characterization of 68Ga-DOTA-D-Phe1-Tyr3-octreotide kinetics in patients with meningiomas. J Nucl Med. 2005;46(5):763–9.PubMedGoogle Scholar
  66. 66.
    Schulz S, Pauli SU, Handel M, Dietzmann K, Firsching R, Hollt V. Immunohistochemical determination of five somatostatin receptors in meningioma reveals frequent overexpression of somatostatin receptor subtype sst2A. Clin Cancer Res. 2000;6(5):1865–74.PubMedGoogle Scholar
  67. 67.
    Florio T. Molecular mechanisms of the antiproliferative activity of somatostatin receptors (SSTRs) in neuroendocrine tumors. Front Biosci. 2008;13(1):822–40.PubMedCrossRefGoogle Scholar
  68. 68.
    Bruns C, Lewis I, Briner U, Meno-Tetang G, Weckbecker G. SOM230: a novel somatostatin peptidomimetic with broad somatotropin release inhibiting factor (SRIF) receptor binding and a unique antisecretory profile. Eur J Endocrinol. 2002;146(5):707–16.PubMedCrossRefGoogle Scholar
  69. 69.
    Bartolomei M, Bodei L, De Cicco C, Grana CM, Cremonesi M, Botteri E, et al. Peptide receptor radionuclide therapy with (90)Y-DOTATOC in recurrent meningioma. Eur J Nucl Med Mol Imaging. 2009;36(9):1407–16.PubMedCrossRefGoogle Scholar
  70. 70.
    • Kreissl MC, Hanscheid H, Lohr M, Verburg FA, Schiller M, Lassmann M, et al. Combination of peptide receptor radionuclide therapy with fractionated external beam radiotherapy for treatment of advanced symptomatic meningioma. Radiat Oncol. 2012;7:99. ‘Upfront’ use of 177 Lu-DOTATOC in newly diagnosed meningioma WHO I.PubMedCrossRefGoogle Scholar
  71. 71.
    Mason WP, Gentili F, Macdonald DR, Hariharan S, Cruz CR, Abrey LE. Stabilization of disease progression by hydroxyurea in patients with recurrent or unresectable meningioma. J Neurosurg. 2002;97(2):341–6.PubMedCrossRefGoogle Scholar
  72. 72.
    Chamberlain MC. Hydroxyurea for recurrent surgery and radiation refractory high-grade meningioma. J Neurooncol. 2012;107(2):315–21.PubMedCrossRefGoogle Scholar
  73. 73.
    Chamberlain MC, Tsao-Wei DD, Groshen S. Temozolomide for treatmentresistant recurrent meningioma. Neurology. 2004;62(7):1210–2.PubMedCrossRefGoogle Scholar
  74. 74.
    Goodwin JW, Crowley J, Eyre HJ, Stafford B, Jaeckle KA, Townsend JJ. A phase II evaluation of tamoxifen in unresectable or refractory meningiomas: a Southwest Oncology Group study. J Neurooncol. 1993;15(1):75–7.PubMedCrossRefGoogle Scholar
  75. 75.
    Grunberg SM, Weiss MH, Russell CA, Spitz IM, Ahmadi J, Sadun A, et al. Long-term administration of mifepristone (RU486): clinical tolerance during extended treatment of meningioma. Cancer Invest. 2006;24(8):727–33.PubMedCrossRefGoogle Scholar
  76. 76.
    Chamberlain MC, Glantz MJ, Fadul CE. Recurrent meningioma: salvage therapy with long-acting somatostatin analogue. Neurology. 2007;69(10):969–73.PubMedCrossRefGoogle Scholar
  77. 77.
    Johnson DR, Kimmel DW, Burch PA, Cascino TL, Giannini C, Wu W, et al. Phase II study of subcutaneous octreotide in adults with recurrent or progressive meningioma and meningeal hemangiopericytoma. Neuro Oncol. 2011;13(5):530–5.PubMedCrossRefGoogle Scholar
  78. 78.
    Nayak L, Iwamoto FM, Rudnick JD, Norden AD, Lee EQ, Drappatz J, et al. Atypical and anaplastic meningiomas treated with bevacizumab. J Neurooncol. 2012;109(1):187–93.PubMedCrossRefGoogle Scholar
  79. 79.
    Lou E, Sumrall AL, Turner S, Peters KB, Desjardins A, Vredenburgh JJ, et al. Bevacizumab therapy for adults with recurrent/progressive meningioma: a retrospective series. J Neurooncol. 2012;109(1):63–70.PubMedCrossRefGoogle Scholar
  80. 80.
    Horak P, Wohrer A, Hassler M, Hainfellner J, Preusser M, Marosi C. Imatinib mesylate treatment of recurrent meningiomas in preselected patients: a retrospective analysis. J Neurooncol. 2012;109(2):323–30.PubMedCrossRefGoogle Scholar
  81. 81.
    Norden AD, Raizer JJ, Abrey LE, Lamborn KR, Lassman AB, Chang SM, et al. Phase II trials of erlotinib or gefitinib in patients with recurrent meningioma. J Neurooncol. 2010;96(2):211–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of NeurosurgeryCantonal HospitalAarauSwitzerland
  2. 2.Department of Neurology & Brain Tumor CenterCantonal HospitalAarauSwitzerland
  3. 3.University of Basel, School of MedicineBaselSwitzerland

Personalised recommendations