Meningioma natural history: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, patients with meningioma may progress to develop morning [[headache]], focal [[neurological]] deficit, and [[altered mental status]]. Common complications of meningioma include [[increased intracranial pressure]], [[cranial nerve palsies]], and [[hydrocephalus]]. Prognosis is generally good, and the survival rate of patients with meningioma mainly depends on the grade and location of the [[tumor]]. | If left untreated, patients with meningioma may progress to develop morning [[headache]], focal [[neurological]] deficit, and [[altered mental status]]. Common complications of meningioma include [[increased intracranial pressure]], [[cranial nerve palsies]], and [[hydrocephalus]]. Prognosis is generally good, and the survival rate of patients with meningioma mainly depends on the grade and location of the [[tumor]]. | ||
==Natural History== | ==Natural History== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]
Overview
If left untreated, patients with meningioma may progress to develop morning headache, focal neurological deficit, and altered mental status. Common complications of meningioma include increased intracranial pressure, cranial nerve palsies, and hydrocephalus. Prognosis is generally good, and the survival rate of patients with meningioma mainly depends on the grade and location of the tumor.
Natural History
- The median age at diagnosis of meningioma is about 65 years, with incidence increasing with advancing age.[1]
- Most patients with meningioma are asymptomatic. If left untreated, patients with meningioma may progress to develop morning headache, focal neurological deficit, and altered mental status.[2]
- Absence of calcification, age 60 or younger, and initial tumor diameter of greater than 25mm are among the factors associated with a short time to progression.[3]
- Linear growth may be seen in 44% of patients, while volumetric growth may be seen in 74%.[3]
- A higher annual growth rate may be seen in patients with an initial tumor diameter of greater than 25mm, MR imaging T2 signal hyperintensity, patients presenting with symptoms and edema, and male patients.[3]
- Meningomas are usually single but can be multiple in about 1-10% of patients. Multiple meningiomas are usually seen in patients with neurofibromatosis.[4][5]
- 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.[6]
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.[9]
- 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.[10]
- The prognostic factors in patients with anaplastic meningioma include brain invasion, adjuvant radiotherapy, malignant progression, p53 over expression, and extent of resection.[10]
- There may be a chance of recurrence of higher grade meningiomas even if they received gross-total resection or not.[9]
- Grade 1 meningioma is associated with a median survival of approximately 10 years.[11]
- 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.[9]
- Progesterone positive tumors tend to have lower proliferation indices resulting in a better prognosis than those that are progesterone receptor negative.[9]
- 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.[12]
- The table below lists common prognostic factors for meningioma:[13]
| Prognostic Factor | Description |
| Age | Older age is associated with a worse prognosis |
| Anatomical location | Meningioma located at the base of the skull is associated with a poor prognosis due to difficult surgical resection. |
| Labeling index using MIB-1 test | A greater MIB-1 labeling index is associated with a worse prognosis. |
| Histological grade | A grade 3 anaplastic meningioma is associated with the worst prognosis. |
| Functional neurological status | Low score on the Karnofsky Performance Scale is associated with a worse prognosis. |
| Sex hormone receptor | Meningiomas that lack progesterone receptors are associated with a worse prognosis due to a higher recurrence rate following surgery.[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 Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_ref-17 Accessed on September, 25 2015
- ↑ 3.0 3.1 3.2 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.
- ↑ 9.0 9.1 9.2 9.3 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.
- ↑ 10.0 10.1 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.
- ↑ 11.0 11.1 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.
- ↑ Meningioma: Stages and Grades Cancer.net(2015) http://www.cancer.net/cancer-types/meningioma/stages-and-grades Accessed on September, 25 2015