View source for Meningioma

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{{Infobox_Disease |
  Name           = {{PAGENAME}} |
  Image          = Contrast enhanced meningioma.jpg |
  Caption        = |
  DiseasesDB     = 8008 |
  ICD10          = C70, D32 |
  ICD9           = {{ICD9|225.2}} |
  ICDO           = 9530  |
  OMIM           = |
  MedlinePlus    = |
  eMedicineSubj  = neuro |
  eMedicineTopic = 209 |
  eMedicine_mult = {{eMedicine2|radio|439}} |
  MeshID         = D008579 |
}}
{{Search infobox}}
{{CMG}}

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==Overview==
'''Meningiomas''' are the most common [[benign]] [[tumor]]s of the [[brain]] (95% of benign tumors). However they can also be [[malignant]]. They arise from the arachnoidal cap cells of the [[meninges]] and represent about 15% of all primary brain tumors. They are more common in [[female]]s than in [[male]]s (2:1) and have a peak incidence in the sixth and seventh decades. Most cases are sporadic while some are familial. There has been some evidence that persons who have undergone [[radiation]] to the [[scalp]] are more at risk for developing meningiomas. The most frequent genetic mutations involved in meningiomas are inactivation mutations in the neurofibromatosis 2 [[gene]] (merlin) on [[chromosome]] 22q. 

==Pathogenesis==
Meningiomas arise from arachnoidal cells, most of which are near the vicinity of the venous sinuses, and this is the site of greatest prevalence for meningioma formation. They are most frequently attached to the dura over the superior parasagittal surface of frontal and parietal lobes, along the sphenoid ridge, in the [[olfactory]] grooves, the sylvian region, superior [[cerebellum]] along the ''[[falx cerebri]]'', [[cerebellopontine angle]], and the [[spinal cord]]. The tumor is usually gray, well-circumscribed, and takes on the form of space it occupies. They are usually dome-shaped, with the base lying on the [[dura]]. 

Histologically, the cells are relatively uniform, with a tendency to encircle one another, forming whorls and [[psammoma body|psammoma bodies]] (laminated calcific concretions). They have a tendency to calcify and are highly vascularized.

==Clinical manifestations==
{{main|brain tumor}}
Small tumors (e.g., < 2.0 cm) are usually incidental findings at [[autopsy]] without having caused [[symptom]]s. Larger tumors can cause symptoms depending on the size and location. 
*''[[Focal seizures]]'' may be caused by meningiomas that overlie the cerebrum
*''Progressive spastic weakness in legs'' and ''incontinence'' may be caused by tumors that overlie the parasagittal frontoparietal region.
*''Sylvian tumors'' may cause a myriad of motor, sensory, aphasic, and seizure symptoms depending on the location.
*''[[intracranial pressure#Increased ICP|Increased intracranial pressure]]'' eventually occurs, but is less frequent than in [[glioma]]s.

==Diagnosis==
Meningiomas are readily visualized with contrast [[CT]], [[MRI]] with gadolinium, and arteriography, all attributed to the fact that meningiomas are extra axial and vascularized. CSF protein is usually elevated if [[lumbar puncture]] is attempted.

==Treatment==
*'''''Surgical resection''''' -- Meningiomas can usually be surgically resected with permanent cure if the tumor is superficial on the dural surface and easily accessible. Transarterial [[embolization]] has become a standard preoperative procedure in the preoperative management. [http://www.aans.org/education/journal/neurosurgical/july03/15-1-10.pdf] For incompletely accessible tumors, recurrence is likely. These regions include the medial [[sphenoid bone]], parasellar region, or anterior brainstem. If invasion of the adjacent bone occurs, total removal is nearly impossible. [[Malignant]] transformation is rare. 

*'''''Radiation therapy''''', including [[Gamma Knife]] or proton beam treatment, may be pursued in cases of inoperable or unresectable tumors, or if tumor shows malignant transformation. Focused radiation may also be helpful for small tumors at the base of the skull. 

*'''''Conventional chemotherapy''''' is likely not effective. Antiprogestin agents have been used, but with variable results. Recent evidence that [[hydroxyurea]] has the capacity to shrink unresectable or recurrent meningiomas is being further evaluated.

==See also==
* [[Sphenoid wing meningioma]]
* [[Optic nerve sheath meningioma]]

==External links==
* [http://www.mayoclinic.com/health/meningioma/DS00901 Meningioma information] from the [[Mayo Clinic]]
* [http://www.meningiomamommas.org Meningioma Mommas - An online support group for all those (both women and men) affected by meningioma brain tumors]
* [http://rad.usuhs.edu/medpix/medpix.html?mode=image_finder&srchstr=meningioma&srch_type=all&action=search#top Images of meningiomas] from MedPix
* [http://www.brighamandwomens.org/neurosurgery/meningioma/meningiomafacts.asp Brigham and Woman's Hospital]
* [http://www.cancerbackup.org.uk/Cancertype/Brain/Typesofbraintumour/Meningioma CancerBackup]
* [http://www.meningiomauk.org/ Meningioma UK Support]
* [http://www.gamma-knife-surgery.com/gammaKnife/meningiomas.asp Gamma Knife Video]

{{Nervous tissue tumors}}
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[[Category:Neurological disorders]]
[[Category:Neurosurgery]]
[[Category:Types of cancer]]
[[Category:Oncology]]

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