Incidental meningioma management
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