Meningioma natural history: Difference between revisions
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{{Meningioma}} | {{Meningioma}} | ||
{{CMG}} {{AE}}{{HL}} | {{CMG}} {{AE}} {{IO}} {{HL}} | ||
==Overview== | ==Overview== | ||
If left untreated, patients with meningioma may progress to | The incidence of meningioma increases with advancing age, with the median age of diagnosis being about 65 years. There are some factors associated with faster progression of the [[tumor]], they include absence of [[calcification]], age 60 or younger, and intial [[tumor]] diameter greater than 25mm. Meningiomas can grow in a linear or volumetric fashion. They can grow anywhere in the [[central nervous system]] containing [[arachnoid membrane]]. If left untreated, patients with meningioma may progress to developing morning [[headaches]], focal neurological deficits, [[edema]] surrounding the [[tumor]], [[cranial nerve palsies]], and more. [[Prognosis]] is generally good, and the [[survival rate]] of patients with meningioma mainly depends on the grade and the extent of resection of the [[tumor]]. | ||
==Natural History== | ==Natural History, Complications, and Prognosis== | ||
* The median age at diagnosis of meningioma is about 65 years, with incidence increasing with advancing age.<ref name="pmid25872752">{{cite journal| author=Dolecek TA, Dressler EV, Thakkar JP, Liu M, Al-Qaisi A, Villano JL| title=Epidemiology of meningiomas post-Public Law 107-206: The Benign Brain Tumor Cancer Registries Amendment Act. | journal=Cancer | year= 2015 | volume= 121 | issue= 14 | pages= 2400-10 | pmid=25872752 | doi=10.1002/cncr.29379 | pmc=5549267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25872752 }} </ref> | * The [[median]] age at [[diagnosis]] of meningioma is about 65 years, with [[incidence]] increasing with advancing age.<ref name="pmid25872752">{{cite journal| author=Dolecek TA, Dressler EV, Thakkar JP, Liu M, Al-Qaisi A, Villano JL| title=Epidemiology of meningiomas post-Public Law 107-206: The Benign Brain Tumor Cancer Registries Amendment Act. | journal=Cancer | year= 2015 | volume= 121 | issue= 14 | pages= 2400-10 | pmid=25872752 | doi=10.1002/cncr.29379 | pmc=5549267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25872752 }} </ref> | ||
* | * Absence of [[calcification]], age 60 or younger, and initial [[tumor]] diameter of greater than 25 mm are among the factors associated with a short time to progression.<ref name="pmid21250802">{{cite journal| author=Oya S, Kim SH, Sade B, Lee JH| title=The natural history of intracranial meningiomas. | journal=J Neurosurg | year= 2011 | volume= 114 | issue= 5 | pages= 1250-6 | pmid=21250802 | doi=10.3171/2010.12.JNS101623 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21250802 }} </ref> | ||
* Linear growth may be seen in 44% of the patients, while volumetric growth may be seen in 74%.<ref name="pmid21250802">{{cite journal| author=Oya S, Kim SH, Sade B, Lee JH| title=The natural history of intracranial meningiomas. | journal=J Neurosurg | year= 2011 | volume= 114 | issue= 5 | pages= 1250-6 | pmid=21250802 | doi=10.3171/2010.12.JNS101623 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21250802 }} </ref> | |||
* Linear growth may be seen in 44% of patients, while volumetric growth may be seen in 74%.<ref name="pmid21250802">{{cite journal| author=Oya S, Kim SH, Sade B, Lee JH| title=The natural history of intracranial meningiomas. | journal=J Neurosurg | year= 2011 | volume= 114 | issue= 5 | pages= 1250-6 | pmid=21250802 | doi=10.3171/2010.12.JNS101623 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21250802 }} </ref> | * A higher annual growth rate may be seen in patients with an initial [[tumor]] diameter of greater than 25 mm, MR imaging T2 signal hyperintensity, patients presenting with symptoms and [[edema]], and male patients.<ref name="pmid21250802">{{cite journal| author=Oya S, Kim SH, Sade B, Lee JH| title=The natural history of intracranial meningiomas. | journal=J Neurosurg | year= 2011 | volume= 114 | issue= 5 | pages= 1250-6 | pmid=21250802 | doi=10.3171/2010.12.JNS101623 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21250802 }} </ref> | ||
* A higher annual growth rate may be seen in patients with an initial tumor diameter of greater than | * Meningomas are usually single but can be multiple in about 1 - 10% of the patients. Multiple meningiomas are usually seen in patients with [[neurofibromatosis]].<ref name="pmid23776757">{{cite journal| author=Wong RH, Wong AK, Vick N, Farhat HI| title=Natural history of multiple meningiomas. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= | pages= 71 | pmid=23776757 | doi=10.4103/2152-7806.112617 | pmc=3683641 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23776757 }} </ref><ref name="pmid6864264">{{cite journal| author=Sheehy JP, Crockard HA| title=Multiple meningiomas: a long-term review. | journal=J Neurosurg | year= 1983 | volume= 59 | issue= 1 | pages= 1-5 | pmid=6864264 | doi=10.3171/jns.1983.59.1.0001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6864264 }} </ref> | ||
* Meningomas are usually single but can be multiple in about 1-10% of patients. Multiple meningiomas are usually seen in patients with neurofibromatosis.<ref name="pmid23776757">{{cite journal| author=Wong RH, Wong AK, Vick N, Farhat HI| title=Natural history of multiple meningiomas. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= | pages= 71 | pmid=23776757 | doi=10.4103/2152-7806.112617 | pmc=3683641 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23776757 }} </ref><ref name="pmid6864264">{{cite journal| author=Sheehy JP, Crockard HA| title=Multiple meningiomas: a long-term review. | journal=J Neurosurg | year= 1983 | volume= 59 | issue= 1 | pages= 1-5 | pmid=6864264 | doi=10.3171/jns.1983.59.1.0001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6864264 }} </ref> | |||
* The rate of growth in patients with multiple meningiomas is similar to those with solitary meningiomas. | * The rate of growth in patients with multiple meningiomas is similar to those with solitary meningiomas. | ||
* Meningiomas can grow anywhere in the central nervous system containing arachnoid membrane. For example, between the brain and the cranium, in the ventricles, down the spinal canal.<ref name="pmid30740161">{{cite journal| author=Sumkovski R, Micunovic M, Kocevski I, Ilievski B, Petrov I| title=Surgical Treatment of Meningiomas - Outcome Associated With Type of Resection, Recurrence, Karnofsky Performance Score, Mitotic Count. | journal=Open Access Maced J Med Sci | year= 2019 | volume= 7 | issue= 1 | pages= 56-64 | pmid=30740161 | doi=10.3889/oamjms.2018.503 | pmc=6352459 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30740161 }} </ref> | * Meningiomas can grow anywhere in the [[central nervous system]] containing [[arachnoid membrane]]. For example, between the [[brain]] and the [[cranium]], in the [[Ventricle|ventricles]], down the [[spinal canal]].<ref name="pmid30740161">{{cite journal| author=Sumkovski R, Micunovic M, Kocevski I, Ilievski B, Petrov I| title=Surgical Treatment of Meningiomas - Outcome Associated With Type of Resection, Recurrence, Karnofsky Performance Score, Mitotic Count. | journal=Open Access Maced J Med Sci | year= 2019 | volume= 7 | issue= 1 | pages= 56-64 | pmid=30740161 | doi=10.3889/oamjms.2018.503 | pmc=6352459 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30740161 }} </ref> | ||
===Complications=== | |||
* Common complications of meningioma include:<ref name="pmid25744347">{{cite journal| author=Shibuya M| title=Pathology and molecular genetics of meningioma: recent advances. | journal=Neurol Med Chir (Tokyo) | year= 2015 | volume= 55 | issue= 1 | pages= 14-27 | pmid=25744347 | doi=10.2176/nmc.ra.2014-0233 | pmc=4533397 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25744347 }} </ref><ref name="Komotar2003">{{cite journal|last1=Komotar|first1=R J|title=Meningioma presenting as stroke: report of two cases and estimation of incidence|journal=Journal of Neurology, Neurosurgery & Psychiatry|volume=74|issue=1|year=2003|pages=136–137|issn=00223050|doi=10.1136/jnnp.74.1.136}}</ref> | |||
:* [[Increased intracranial pressure]] | :* [[Increased intracranial pressure]] | ||
:* [[Cranial nerve palsies]] | :* [[Cranial nerve palsies]] | ||
:* [[Hydrocephalus]] | :* [[Hydrocephalus]] | ||
:* Peritumoral brain edema | :* Peritumoral [[brain edema]] | ||
:* Stroke: Due to occlusion of the internal carotid artery seen in meningiomas located at the skull base | :* [[Stroke]]: Due to occlusion of the [[internal carotid artery]]. This can be seen in meningiomas located at the [[skull]] base | ||
==Prognosis== | ===Prognosis=== | ||
* The prognosis of meningioma is usually determined by 2 of the most important factors which are the extent of the resection and the histological grade of the tumor.<ref name="ComminsAtkinson2007">{{cite journal|last1=Commins|first1=Deborah L.|last2=Atkinson|first2=Roscoe D.|last3=Burnett|first3=Margaret E.|title=Review of meningioma histopathology|journal=Neurosurgical Focus|volume=23|issue=4|year=2007|pages=E3|issn=1092-0684|doi=10.3171/FOC-07/10/E3}}</ref> | |||
* The 5 year estimated survival for benign tumors is 85.6%, 82.3% for borderline malignant tumors, and 66% for malignant tumors. A poorer survival rate may be seen in patients of advanced age, male patients, black race, malignant tumors, and patients with no initial treatment.<ref name="pmid25872752">{{cite journal| author=Dolecek TA, Dressler EV, Thakkar JP, Liu M, Al-Qaisi A, Villano JL| title=Epidemiology of meningiomas post-Public Law 107-206: The Benign Brain Tumor Cancer Registries Amendment Act. | journal=Cancer | year= 2015 | volume= 121 | issue= 14 | pages= 2400-10 | pmid=25872752 | doi=10.1002/cncr.29379 | pmc=5549267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25872752 }} </ref> | * The prognosis of meningioma is usually determined by 2 of the most important factors which are the extent of the resection and the histological grade of the [[tumor]].<ref name="ComminsAtkinson2007">{{cite journal|last1=Commins|first1=Deborah L.|last2=Atkinson|first2=Roscoe D.|last3=Burnett|first3=Margaret E.|title=Review of meningioma histopathology|journal=Neurosurgical Focus|volume=23|issue=4|year=2007|pages=E3|issn=1092-0684|doi=10.3171/FOC-07/10/E3}}</ref> | ||
* Patients with atypical meningioma have a higher overall recurrence-free survival rate than those with anaplastic meningioma.<ref name="pmid17766430">{{cite journal| author=Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW| title=Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. | journal=J Neurol Neurosurg Psychiatry | year= 2008 | volume= 79 | issue= 5 | pages= 574-80 | pmid=17766430 | doi=10.1136/jnnp.2007.121582 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17766430 }} </ref> | * The 5 year estimated survival for [[benign tumors]] is 85.6%, 82.3% for borderline [[malignant tumors]], and 66% for [[malignant tumors]]. A poorer [[survival rate]] may be seen in patients of advanced age, male patients, black race, [[malignant tumors]], and patients with no initial treatment.<ref name="pmid25872752">{{cite journal| author=Dolecek TA, Dressler EV, Thakkar JP, Liu M, Al-Qaisi A, Villano JL| title=Epidemiology of meningiomas post-Public Law 107-206: The Benign Brain Tumor Cancer Registries Amendment Act. | journal=Cancer | year= 2015 | volume= 121 | issue= 14 | pages= 2400-10 | pmid=25872752 | doi=10.1002/cncr.29379 | pmc=5549267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25872752 }} </ref> | ||
* The prognostic factors in patients with anaplastic meningioma include brain invasion, adjuvant radiotherapy, malignant progression, p53 over expression, and extent of resection.<ref name="pmid17766430">{{cite journal| author=Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW| title=Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. | journal=J Neurol Neurosurg Psychiatry | year= 2008 | volume= 79 | issue= 5 | pages= 574-80 | pmid=17766430 | doi=10.1136/jnnp.2007.121582 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17766430 }} </ref> | * Patients with atypical meningioma have a higher overall recurrence-free [[survival rate]] than those with anaplastic meningioma.<ref name="pmid17766430">{{cite journal| author=Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW| title=Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. | journal=J Neurol Neurosurg Psychiatry | year= 2008 | volume= 79 | issue= 5 | pages= 574-80 | pmid=17766430 | doi=10.1136/jnnp.2007.121582 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17766430 }} </ref> | ||
* The prognostic factors in patients with anaplastic meningioma include brain invasion, adjuvant radiotherapy, [[malignant]] progression, [[p53]] over expression, and extent of resection.<ref name="pmid17766430">{{cite journal| author=Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW| title=Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. | journal=J Neurol Neurosurg Psychiatry | year= 2008 | volume= 79 | issue= 5 | pages= 574-80 | pmid=17766430 | doi=10.1136/jnnp.2007.121582 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17766430 }} </ref> | |||
* There may be a chance of recurrence of higher grade meningiomas even if they received gross-total resection or not.<ref name="ComminsAtkinson2007">{{cite journal|last1=Commins|first1=Deborah L.|last2=Atkinson|first2=Roscoe D.|last3=Burnett|first3=Margaret E.|title=Review of meningioma histopathology|journal=Neurosurgical Focus|volume=23|issue=4|year=2007|pages=E3|issn=1092-0684|doi=10.3171/FOC-07/10/E3}}</ref> | * There may be a chance of recurrence of higher grade meningiomas even if they received gross-total resection or not.<ref name="ComminsAtkinson2007">{{cite journal|last1=Commins|first1=Deborah L.|last2=Atkinson|first2=Roscoe D.|last3=Burnett|first3=Margaret E.|title=Review of meningioma histopathology|journal=Neurosurgical Focus|volume=23|issue=4|year=2007|pages=E3|issn=1092-0684|doi=10.3171/FOC-07/10/E3}}</ref> | ||
* Grade 1 meningioma is associated with a median survival of approximately 10 years.<ref name="pmid23463172">{{cite journal| author=Fathi AR, Roelcke U| title=Meningioma. | journal=Curr Neurol Neurosci Rep | year= 2013 | volume= 13 | issue= 4 | pages= 337 | pmid=23463172 | doi=10.1007/s11910-013-0337-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23463172 }} </ref> | * Grade 1 meningioma is associated with a median survival of approximately 10 years.<ref name="pmid23463172">{{cite journal| author=Fathi AR, Roelcke U| title=Meningioma. | journal=Curr Neurol Neurosci Rep | year= 2013 | volume= 13 | issue= 4 | pages= 337 | pmid=23463172 | doi=10.1007/s11910-013-0337-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23463172 }} </ref> | ||
* Grade 3 meningioma is associated with a median survival of approximately 2.7 years. | * Grade 3 meningioma is associated with a median survival of approximately 2.7 years. | ||
* For classic tumors, the 5 year recurrence rate is about 12%, and they are not associated with a decreased overall length of survival. Unlike atypical tumors which have a 41% recurrence rate and decreased overall length of survival.<ref name="ComminsAtkinson2007">{{cite journal|last1=Commins|first1=Deborah L.|last2=Atkinson|first2=Roscoe D.|last3=Burnett|first3=Margaret E.|title=Review of meningioma histopathology|journal=Neurosurgical Focus|volume=23|issue=4|year=2007|pages=E3|issn=1092-0684|doi=10.3171/FOC-07/10/E3}}</ref> | * For classic tumors, the 5 year recurrence rate is about 12%, and they are not associated with a decreased overall length of survival. Unlike atypical tumors which have a 41% recurrence rate and decreased overall length of survival.<ref name="ComminsAtkinson2007">{{cite journal|last1=Commins|first1=Deborah L.|last2=Atkinson|first2=Roscoe D.|last3=Burnett|first3=Margaret E.|title=Review of meningioma histopathology|journal=Neurosurgical Focus|volume=23|issue=4|year=2007|pages=E3|issn=1092-0684|doi=10.3171/FOC-07/10/E3}}</ref> | ||
* Progesterone positive tumors tend to have lower proliferation indices resulting in a better prognosis than those that are progesterone receptor negative.<ref name="ComminsAtkinson2007">{{cite journal|last1=Commins|first1=Deborah L.|last2=Atkinson|first2=Roscoe D.|last3=Burnett|first3=Margaret E.|title=Review of meningioma histopathology|journal=Neurosurgical Focus|volume=23|issue=4|year=2007|pages=E3|issn=1092-0684|doi=10.3171/FOC-07/10/E3}}</ref> | *[[Progesterone]] positive [[Tumor|tumors]] tend to have lower proliferation indices resulting in a better prognosis than those that are [[progesterone]] [[Receptor (biochemistry)|receptor]] negative.<ref name="ComminsAtkinson2007">{{cite journal|last1=Commins|first1=Deborah L.|last2=Atkinson|first2=Roscoe D.|last3=Burnett|first3=Margaret E.|title=Review of meningioma histopathology|journal=Neurosurgical Focus|volume=23|issue=4|year=2007|pages=E3|issn=1092-0684|doi=10.3171/FOC-07/10/E3}}</ref> | ||
* The tumors that are positive for estrogen receptors and those negative for both estrogen and progesterone receptors have an increased potential for aggressive clinical behavior, progression and recurrence.<ref name="PravdenkovaAl-Mefty2006">{{cite journal|last1=Pravdenkova|first1=Svetlana|last2=Al-Mefty|first2=Ossama|last3=Sawyer|first3=Jeffrey|last4=Husain|first4=Muhammad|title=Progesterone and estrogen receptors: opposing prognostic indicators in meningiomas|journal=Journal of Neurosurgery|volume=105|issue=2|year=2006|pages=163–173|issn=0022-3085|doi=10.3171/jns.2006.105.2.163}}</ref> | * The [[Tumor|tumors]] that are positive for [[estrogen]] [[Receptor (biochemistry)|receptors]] and those negative for both [[estrogen]] and [[progesterone]] [[Receptor (biochemistry)|receptors]] have an increased potential for aggressive clinical behavior, progression and recurrence.<ref name="PravdenkovaAl-Mefty2006">{{cite journal|last1=Pravdenkova|first1=Svetlana|last2=Al-Mefty|first2=Ossama|last3=Sawyer|first3=Jeffrey|last4=Husain|first4=Muhammad|title=Progesterone and estrogen receptors: opposing prognostic indicators in meningiomas|journal=Journal of Neurosurgery|volume=105|issue=2|year=2006|pages=163–173|issn=0022-3085|doi=10.3171/jns.2006.105.2.163}}</ref> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
Latest revision as of 20:08, 20 September 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ifeoma Odukwe, M.D. [2] Haytham Allaham, M.D. [3]
Overview
The incidence of meningioma increases with advancing age, with the median age of diagnosis being about 65 years. There are some factors associated with faster progression of the tumor, they include absence of calcification, age 60 or younger, and intial tumor diameter greater than 25mm. Meningiomas can grow in a linear or volumetric fashion. They can grow anywhere in the central nervous system containing arachnoid membrane. If left untreated, patients with meningioma may progress to developing morning headaches, focal neurological deficits, edema surrounding the tumor, cranial nerve palsies, and more. Prognosis is generally good, and the survival rate of patients with meningioma mainly depends on the grade and the extent of resection of the tumor.
Natural History, Complications, and Prognosis
- The median age at diagnosis of meningioma is about 65 years, with incidence increasing with advancing age.[1]
- Absence of calcification, age 60 or younger, and initial tumor diameter of greater than 25 mm are among the factors associated with a short time to progression.[2]
- Linear growth may be seen in 44% of the patients, while volumetric growth may be seen in 74%.[2]
- A higher annual growth rate may be seen in patients with an initial tumor diameter of greater than 25 mm, MR imaging T2 signal hyperintensity, patients presenting with symptoms and edema, and male patients.[2]
- Meningomas are usually single but can be multiple in about 1 - 10% of the patients. Multiple meningiomas are usually seen in patients with neurofibromatosis.[3][4]
- The rate of growth in patients with multiple meningiomas is similar to those with solitary meningiomas.
- Meningiomas can grow anywhere in the central nervous system containing arachnoid membrane. For example, between the brain and the cranium, in the ventricles, down the spinal canal.[5]
Complications
- Increased intracranial pressure
- Cranial nerve palsies
- Hydrocephalus
- Peritumoral brain edema
- Stroke: Due to occlusion of the internal carotid artery. This can be seen in meningiomas located at the skull base
Prognosis
- The prognosis of meningioma is usually determined by 2 of the most important factors which are the extent of the resection and the histological grade of the tumor.[8]
- The 5 year estimated survival for benign tumors is 85.6%, 82.3% for borderline malignant tumors, and 66% for malignant tumors. A poorer survival rate may be seen in patients of advanced age, male patients, black race, malignant tumors, and patients with no initial treatment.[1]
- Patients with atypical meningioma have a higher overall recurrence-free survival rate than those with anaplastic meningioma.[9]
- The prognostic factors in patients with anaplastic meningioma include brain invasion, adjuvant radiotherapy, malignant progression, p53 over expression, and extent of resection.[9]
- There may be a chance of recurrence of higher grade meningiomas even if they received gross-total resection or not.[8]
- Grade 1 meningioma is associated with a median survival of approximately 10 years.[10]
- Grade 3 meningioma is associated with a median survival of approximately 2.7 years.
- For classic tumors, the 5 year recurrence rate is about 12%, and they are not associated with a decreased overall length of survival. Unlike atypical tumors which have a 41% recurrence rate and decreased overall length of survival.[8]
- Progesterone positive tumors tend to have lower proliferation indices resulting in a better prognosis than those that are progesterone receptor negative.[8]
- The tumors that are positive for estrogen receptors and those negative for both estrogen and progesterone receptors have an increased potential for aggressive clinical behavior, progression and recurrence.[11]
References
- ↑ 1.0 1.1 Dolecek TA, Dressler EV, Thakkar JP, Liu M, Al-Qaisi A, Villano JL (2015). "Epidemiology of meningiomas post-Public Law 107-206: The Benign Brain Tumor Cancer Registries Amendment Act". Cancer. 121 (14): 2400–10. doi:10.1002/cncr.29379. PMC 5549267. PMID 25872752.
- ↑ 2.0 2.1 2.2 Oya S, Kim SH, Sade B, Lee JH (2011). "The natural history of intracranial meningiomas". J Neurosurg. 114 (5): 1250–6. doi:10.3171/2010.12.JNS101623. PMID 21250802.
- ↑ Wong RH, Wong AK, Vick N, Farhat HI (2013). "Natural history of multiple meningiomas". Surg Neurol Int. 4: 71. doi:10.4103/2152-7806.112617. PMC 3683641. PMID 23776757.
- ↑ Sheehy JP, Crockard HA (1983). "Multiple meningiomas: a long-term review". J Neurosurg. 59 (1): 1–5. doi:10.3171/jns.1983.59.1.0001. PMID 6864264.
- ↑ Sumkovski R, Micunovic M, Kocevski I, Ilievski B, Petrov I (2019). "Surgical Treatment of Meningiomas - Outcome Associated With Type of Resection, Recurrence, Karnofsky Performance Score, Mitotic Count". Open Access Maced J Med Sci. 7 (1): 56–64. doi:10.3889/oamjms.2018.503. PMC 6352459. PMID 30740161.
- ↑ Shibuya M (2015). "Pathology and molecular genetics of meningioma: recent advances". Neurol Med Chir (Tokyo). 55 (1): 14–27. doi:10.2176/nmc.ra.2014-0233. PMC 4533397. PMID 25744347.
- ↑ Komotar, R J (2003). "Meningioma presenting as stroke: report of two cases and estimation of incidence". Journal of Neurology, Neurosurgery & Psychiatry. 74 (1): 136–137. doi:10.1136/jnnp.74.1.136. ISSN 0022-3050.
- ↑ 8.0 8.1 8.2 8.3 Commins, Deborah L.; Atkinson, Roscoe D.; Burnett, Margaret E. (2007). "Review of meningioma histopathology". Neurosurgical Focus. 23 (4): E3. doi:10.3171/FOC-07/10/E3. ISSN 1092-0684.
- ↑ 9.0 9.1 Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW (2008). "Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features". J Neurol Neurosurg Psychiatry. 79 (5): 574–80. doi:10.1136/jnnp.2007.121582. PMID 17766430.
- ↑ Fathi AR, Roelcke U (2013). "Meningioma". Curr Neurol Neurosci Rep. 13 (4): 337. doi:10.1007/s11910-013-0337-4. PMID 23463172.
- ↑ Pravdenkova, Svetlana; Al-Mefty, Ossama; Sawyer, Jeffrey; Husain, Muhammad (2006). "Progesterone and estrogen receptors: opposing prognostic indicators in meningiomas". Journal of Neurosurgery. 105 (2): 163–173. doi:10.3171/jns.2006.105.2.163. ISSN 0022-3085.