Incidental meningioma management [Neurosurgery Wiki]

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====== Incidental meningioma management ======

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===== Key Principles of Management =====

Initial Assessment:

Confirm diagnosis with MRI (including contrast-enhanced sequences).

Rule out alternative diagnoses (e.g., metastasis, hemangiopericytoma).

Document baseline size, location, and radiological features (e.g., calcifications, edema, dural tail, brain invasion).

Risk Stratification: Factors predicting progression include:

Tumor size > 3 cm

Skull base or eloquent location

Absence of calcification

Peritumoral edema

Hyperintensity on T2

Rapid growth on serial imaging

===== Management Options =====

see [[Incidental meningioma active surveillance]]

Most common approach for small, asymptomatic tumors.

Serial MRIs: every 6 months initially, then yearly if stable.

===== Surgical Resection =====

Considered for tumors showing growth, causing mass effect, or in younger patients where long-term monitoring is less ideal.

Also considered if tumor is accessible with low expected morbidity.

===== Radiation Therapy =====

Stereotactic radiosurgery (SRS) or fractionated radiotherapy may be offered in selected cases.

Typically reserved for growing lesions not amenable to surgery or in older/frail patients.

===== Follow-up Strategy =====

No universal consensus, but typically:

MRI at 6 months after diagnosis

If stable: yearly imaging for 5 years, then spacing out

Lifelong follow-up is generally advised for younger patients

===== Decision-making Considerations =====

Patient age and comorbidities

Tumor location and size

Radiological features of aggressiveness

Patient preference and anxiety levels

Life expectancy and quality of life impact



===== Asymptomatic meningioma treatment =====

see [[Asymptomatic meningioma treatment]].