Meningioma overview: Difference between revisions
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==Overview== | ==Overview== | ||
'''Meningioma''' is a relatively common neoplasm of the central nervous system that arises from arachnoidal cells which are normally involved in the protection of the [[brain]] and [[spinal cord]] by forming a thick envelope of meninges around them. | '''Meningioma''' is a relatively common neoplasm of the central nervous system that arises from arachnoidal cells which are normally involved in the protection of the [[brain]] and [[spinal cord]] by forming a thick envelope of meninges around them. Meningioma was first discovered by Dr Felix Platter, a Swiss physician, in the 16th century.<ref name="felix">Felix Plater. Wikipedia(2015) https://en.wikipedia.org/wiki/Felix_Plater Accessed on September, 25 2015</ref><ref name="s">{{cite journal| author=Bir SC, Maiti TK, Bollam P, Nanda A| title=Felix Platter and a historical perspective of the meningioma. | journal=Clin Neurol Neurosurg | year= 2015 | volume= 134 | issue= | pages= 75-8 | pmid=25965286 | doi=10.1016/j.clineuro.2015.02.018 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25965286 }} </ref> Meningioma may be classified according to the histological criteria of the WHO into 3 groups: [[benign]] classic meningioma (WHO grade 1), atypical meningioma (WHO grade 2), and [[anaplastic]] malignant meningioma (WHO grade 3). Meningioma may also be classified according to the [[tumor]] location into 2 main subtypes: intradural and extradural meningioma.<ref name="wiki">Meningioma diagnosi. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#History_and_nomenclature Accessed on September, 25 2015</ref><ref name="L">Meningioma. Liberpathology(2015) http://librepathology.org/wiki/index.php/Meningioma#Quick_overview Accessed on September, 25 2015</ref> There are no established direct causes for meningioma. Meningioma must be differentiated from other diseases that cause similar presentation such as [[schwannoma]], [[hemangiopericytoma]], and solitary [[fibrous]] [[tumor]].<ref name="L">Meningioma. Liberpathology(2015) http://librepathology.org/wiki/index.php/Meningioma#Gross.2FRadiology Accessed on September, 25 2015</ref> The incidence of meningioma is approximately 7.62 per 100,000 individuals in the United States.<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= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25872752 }} </ref> The prevalence of meningioma was estimated to be 97.5 cases per 100,000 individuals in the United States.<ref name="pmid20821343">{{cite journal| author=Wiemels J, Wrensch M, Claus EB| title=Epidemiology and etiology of meningioma. | journal=J Neurooncol | year= 2010 | volume= 99 | issue= 3 | pages= 307-14 | pmid=20821343 | doi=10.1007/s11060-010-0386-3 | pmc=PMC2945461 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20821343 }} </ref> Common risk factors in the development of meningioma are history of radiation treatment, inherited [[nervous system]] disorder, and female gender.<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#Signs_and_symptoms Accessed on September, 25 2015</ref><ref name="Canada">Risk factors for brain and spinal cord cancer. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/risks/?region=mb Accessed on September, 25 2015</ref><ref name="pmid20821343">{{cite journal| author=Wiemels J, Wrensch M, Claus EB| title=Epidemiology and etiology of meningioma. | journal=J Neurooncol | year= 2010 | volume= 99 | issue= 3 | pages= 307-14 | pmid=20821343 | doi=10.1007/s11060-010-0386-3 | pmc=PMC2945461 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20821343 }} </ref> There is insufficient evidence to recommend routine screening for meningioma. If left untreated, patients with meningioma may progress to develop morning [[headache]], focal [[neurological]] deficit, and [[altered mental status]]. <ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_ref-17 Accessed on September, 25 2015</ref><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> The hallmark symptom of meningioma is morning [[headache]]. Other common symptoms of meningioma include [[weakness]], [[tremor]], and [[seizure]]s.<ref name="wiki"> Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#Signs_and_symptoms Accessed on September, 25 2015</ref><ref name="UCLA">Meningioma Brain Tumor. UCLA Neurosurgery(2015) http://neurosurgery.ucla.edu/body.cfm?id=1123&ref=62&action=detail Accessed on September, 25 2015</ref><ref name="r"> Meningioma. Radiopaedia (2015) http://radiopaedia.org/articles/meningioma Accessed on September, 25 2015</ref> Head [[CT scan]] may be diagnostic of meningioma. Findings on CT scan suggestive of meningioma include homogeneously hyperdense lesion, [[calcification]], [[hyperostosis]], [[lytic]] lesions and [[pneumosinus dilatans]].<ref name="r">Meningioma. Radiopaedia(2015) http://radiopaedia.org/articles/meningioma Accessed on September, 25 2015</ref> Brain [[MRI]] with [[gadolinium]] is the investigation of choice for the diagnosis of meningioma. On brain MRI, meningioma is characterized by a [[homogeneous]], well circumscribed, and extra-axial mass with a broad dural base.<ref name="r">Meningioma. Radiopaedia(2015) http://radiopaedia.org/articles/meningioma Accessed on September, 25 2015</ref> Other imaging studies for meningioma include magnetic resonance spectroscopy, magnetic resonance perfusion, and [[angiography]].<ref name="r"> Meningioma. Radiopaedia(2015) http://radiopaedia.org/articles/meningioma Accessed on September, 25 2015</ref> Bromodeoxyuridine labeling study may be helpful in the diagnosis of meningioma. An elevated bromodeoxyuridine labeling index is suggestive of a rapid growth rate of meningioma and a greater incidence of recurrence following surgical resection.<ref name="pmid2399811">{{cite journal| author=Lee KS, Hoshino T, Rodriguez LA, Bederson J, Davis RL, Wilson CB| title=Bromodeoxyuridine labeling study of intracranial meningiomas: proliferative potential and recurrence. | journal=Acta Neuropathol | year= 1990 | volume= 80 | issue= 3 | pages= 311-7 | pmid=2399811 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2399811 }} </ref> In asymptomatic meningiomas, the decision of [[surgical resection]] must be weighed against the possibility of conservative management according to the patient's age, clinical presentation, and the anatomical location of the [[tumor]].<ref name="pmid15452322">{{cite journal| author=Herscovici Z, Rappaport Z, Sulkes J, Danaila L, Rubin G| title=Natural history of conservatively treated meningiomas. | journal=Neurology | year= 2004 | volume= 63 | issue= 6 | pages= 1133-4 | pmid=15452322 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15452322 }} </ref><ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma Accessed on September, 25 2015</ref> The predominant therapy for meningioma is surgical resection.<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma Accessed on September, 25 2015</ref> Current data suggest that both [[external beam radiotherapy]] and [[radiosurgery]] play an important role in the management of grade II and III meningiomas.<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma Accessed on September, 25 2015</ref><ref name="pmid24207113">{{cite journal| author=Maclean J, Fersht N, Short S| title=Controversies in radiotherapy for meningioma. | journal=Clin Oncol (R Coll Radiol) | year= 2014 | volume= 26 | issue= 1 | pages= 51-64 | pmid=24207113 | doi=10.1016/j.clon.2013.10.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24207113 }} </ref> | ||
==Historical Perspective== | ==Historical Perspective== | ||
Revision as of 16:20, 21 June 2019
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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
Meningioma is a relatively common neoplasm of the central nervous system that arises from arachnoidal cells which are normally involved in the protection of the brain and spinal cord by forming a thick envelope of meninges around them. Meningioma was first discovered by Dr Felix Platter, a Swiss physician, in the 16th century.[1][2] Meningioma may be classified according to the histological criteria of the WHO into 3 groups: benign classic meningioma (WHO grade 1), atypical meningioma (WHO grade 2), and anaplastic malignant meningioma (WHO grade 3). Meningioma may also be classified according to the tumor location into 2 main subtypes: intradural and extradural meningioma.[3][4] There are no established direct causes for meningioma. Meningioma must be differentiated from other diseases that cause similar presentation such as schwannoma, hemangiopericytoma, and solitary fibrous tumor.[4] The incidence of meningioma is approximately 7.62 per 100,000 individuals in the United States.[5] The prevalence of meningioma was estimated to be 97.5 cases per 100,000 individuals in the United States.[6] Common risk factors in the development of meningioma are history of radiation treatment, inherited nervous system disorder, and female gender.[3][7][6] There is insufficient evidence to recommend routine screening for meningioma. If left untreated, patients with meningioma may progress to develop morning headache, focal neurological deficit, and altered mental status. [3][8] The hallmark symptom of meningioma is morning headache. Other common symptoms of meningioma include weakness, tremor, and seizures.[3][9][10] Head CT scan may be diagnostic of meningioma. Findings on CT scan suggestive of meningioma include homogeneously hyperdense lesion, calcification, hyperostosis, lytic lesions and pneumosinus dilatans.[10] Brain MRI with gadolinium is the investigation of choice for the diagnosis of meningioma. On brain MRI, meningioma is characterized by a homogeneous, well circumscribed, and extra-axial mass with a broad dural base.[10] Other imaging studies for meningioma include magnetic resonance spectroscopy, magnetic resonance perfusion, and angiography.[10] Bromodeoxyuridine labeling study may be helpful in the diagnosis of meningioma. An elevated bromodeoxyuridine labeling index is suggestive of a rapid growth rate of meningioma and a greater incidence of recurrence following surgical resection.[11] In asymptomatic meningiomas, the decision of surgical resection must be weighed against the possibility of conservative management according to the patient's age, clinical presentation, and the anatomical location of the tumor.[12][3] The predominant therapy for meningioma is surgical resection.[3] Current data suggest that both external beam radiotherapy and radiosurgery play an important role in the management of grade II and III meningiomas.[3][13]
Historical Perspective
Meningioma was first discovered by Dr Felix Platter, a Swiss physician, in the 16th century. He described the tumor as having the shape of an acorn, fleshy, and full of holes.
Classification
Meningioma may be classified according to the histological criteria of the WHO into 3 groups: benign classic meningioma (WHO grade 1) which is made up of nine variants, atypical meningioma (WHO grade 2) which is made up of three, and anaplastic malignant meningioma (WHO grade 3) made up of three variants.
Pathophysiology
Meningioma arises from the arachnoid "cap" cells, which are normally involved in the protection of the central nervous system by forming a thick envelope of meninges around the brain and spinal cord. Because of the abundance of arachnoid cap cells in the skull base and perivenous sinuses, meningiomas are commonly found in these sites. Some meningiomas may have progesterone receptors which could make the tumor grow in size during pregnancy and in the luteal phase of the menstrual cycle. Meningiomas could be found in various locations such as sphenoid ridge, olfactory grove, falx cerebri, cerebellopontine angle, foramen magnum, ventricles, etc. Though most meningiomas are benign in nature, some may be malignant and this characterization is usually based on brain invasion, frank anaplasia, and distant metastasis. NF2, MEG2, TERT, AKT1, and NDRG2 are some of the genes that may be involved in the pathogenesis of meningioma. Some conditions could be associated with meningioma, they include neurofibromatosis type 2, cowden syndrome, nevoid basal cell carcinoma, multiple endocrine neoplasia 1 (MEN1), etc. On gross pathology, a gray, well-circumscribed, dome-shaped mass is a characteristic finding of meningioma. On microscopic histopathological analysis, meningiomas may have different characeteristics, they include mitotic figures, interdigitating processes and intercellular junctions, prominent nucleoli, necrosis, and increased cellularity.
Causes
There are no established direct causes for meningioma.
Differentiating Meningioma from other Diseases
Meningioma must be differentiated from other diseases that have similar presentation such as schwannoma, oligodendroglioma, pituitary adenoma, hemangioblastoma, etc
Epidemiology and Demographics
The prevalence of meningioma was estimated to be 97.5 cases per 100,000 individuals in the United States. The incidence of meningioma is approximately 7.62 per 100,000 individuals in the United States. Meningiomas may appear at any age, but occur most commonly among patients between 40 to 60 years. Females are more commonly affected with meningiomas than males, with the ratio being 2:1. Meningioma usually affects individuals of the African American race. Caucasian and Latin American individuals are less likely to develop meningioma.
Risk Factors
Common risk factors in the development of meningioma are history of radiation treatment, increasing age, and female gender.
Screening
There is insufficient evidence to recommend routine screening for meningioma.
Natural History, Complications and Prognosis
The median age at diagnosis of meningioma is about 65 years, with incidence increasing with advancing age. 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. Most meningiomas are single with about 1-10% being multiple. 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 histological grade of the tumor and the extent of resection during surgery. A poorer survival rate may be seen in patients of advanced age, male patients, black race, malignant tumors, and patients with no initial treatment.
Diagnosis
Diagnostic Study of Choice
MRI is the gold standard test for the diagnosis of meningioma but CT is more widely available and better in urgent settings.
History and Symptoms
The hallmark symptom of meningioma is headache. Other common symptoms of meningioma include weakness, focal neurological deficits, visual impairement, hearing loss, and confusion. However, the specific clinical presentation of meningioma is determined by the exact anatomical location of the tumor.
Physical Examination
Common physical examination findings of meningioma include decreased visual acuity, hearing loss, ataxia, muscle weakness, focal neurological deficits, and more. Patients with meningioma present with different signs depending on the location of the tumor, its character, and the structures it may compress. Some patients are asymptomatic and may have not present with sign on physical examination.
Laboratory Findings
There are no diagnostic lab findings associated with meningioma.
Electrocardiogram
There are no ECG findings associated with meningioma.
X Ray
Plain radiography no longer has a role in the diagnosis or management of meningioma.
Echocardiography and Ultrasound
There are no echocardiography/ultrasound findings associated with meningioma.
CT
Head CT scan may be diagnostic of meningioma. Some of the findings on CT scan suggestive of meningioma include edema, CSF attenuation cleft, round/elongated extraaxial mass, and hyperostosis of the adjacent skull. Although MRI is the diagnostic study of choice, CT is easier to use and may be used in cases where there is a contraindication to the use of an MRI.
MRI
MRI with gadolinium is the investigation of choice for the diagnosis of meningioma. On MRI, meningioma is characterized by a homogeneous, well circumscribed, and extra-axial mass with a broad dural base. Other findings on MRI suggestive of meningioma include CSF vascular cleft sign, dural tail sign, and central necrosis or calcification that do not enhance. Meningiomas may appear different on T1 and T2-weighted sequence but with a few similarities.
Other Imaging Findings
Other imaging studies that may be helpful in the diagnosis of meningioma include magnetic resonance (MR) spectroscopy, perfusion MRI, and diffusion MRI. With MR spectroscopy, elevated levels of alanine, choline, and/or lactate could be seen. MR perfusion study could demonstrate an elevated value of relative cerebral blood volume (rCBV).
Other Diagnostic Studies
Bromodeoxyuridine labeling study may be helpful in the diagnosis of meningioma. An elevated bromodeoxyuridine labeling index is suggestive of a rapid growth rate of meningioma and a greater incidence of recurrence following surgical resection.
Treatment
Medical Therapy
In asymptomatic meningiomas, the decision of surgical resection must be weighed against the possibility of conservative management according to the patient's age, clinical presentation, and the anatomical location of the tumor.[12][3] Current data suggest that both external beam radiotherapy and radiosurgery play an important role in the management of grade II and III meningiomas.[13][14] Chemotherapeutic agents are generally not effective against meningioma.[3]
Interventions
Asymptomatic meningiomas found incidentally are usually treated expectantly. In cases with tissue edema and vascular compromise, another approach can be taken. Radiotherapy is pursued depending on the patient factor and location of the tumor. It can be done after surgery with little advantage over radiotherapy alone.
Surgery
The predominant therapy for meningioma is surgical resection. Adjunctive radiation therapy may be required among certain patients.[3] The Simpson criteria for meningioma correlates the degree of surgical resection completeness with the probability of post-surgical tumor recurrence.[3][10][15] Surgical resection is not recommended among patients with asymptomatic stable meningioma.[3]
Primary Prevention
There are no established measures for the primary prevention of meningioma.
Secondary Prevention
There are no established measures for the secondary prevention of meningioma.
References
- ↑ Felix Plater. Wikipedia(2015) https://en.wikipedia.org/wiki/Felix_Plater Accessed on September, 25 2015
- ↑ Bir SC, Maiti TK, Bollam P, Nanda A (2015). "Felix Platter and a historical perspective of the meningioma". Clin Neurol Neurosurg. 134: 75–8. doi:10.1016/j.clineuro.2015.02.018. PMID 25965286.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 Meningioma diagnosi. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#History_and_nomenclature Accessed on September, 25 2015
- ↑ 4.0 4.1 Meningioma. Liberpathology(2015) http://librepathology.org/wiki/index.php/Meningioma#Quick_overview Accessed on September, 25 2015
- ↑ 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. PMID 25872752.
- ↑ 6.0 6.1 Wiemels J, Wrensch M, Claus EB (2010). "Epidemiology and etiology of meningioma". J Neurooncol. 99 (3): 307–14. doi:10.1007/s11060-010-0386-3. PMC 2945461. PMID 20821343.
- ↑ Risk factors for brain and spinal cord cancer. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/risks/?region=mb Accessed on September, 25 2015
- ↑ Fathi AR, Roelcke U (2013). "Meningioma". Curr Neurol Neurosci Rep. 13 (4): 337. doi:10.1007/s11910-013-0337-4. PMID 23463172.
- ↑ Meningioma Brain Tumor. UCLA Neurosurgery(2015) http://neurosurgery.ucla.edu/body.cfm?id=1123&ref=62&action=detail Accessed on September, 25 2015
- ↑ 10.0 10.1 10.2 10.3 10.4 Meningioma. Radiopaedia (2015) http://radiopaedia.org/articles/meningioma Accessed on September, 25 2015
- ↑ Lee KS, Hoshino T, Rodriguez LA, Bederson J, Davis RL, Wilson CB (1990). "Bromodeoxyuridine labeling study of intracranial meningiomas: proliferative potential and recurrence". Acta Neuropathol. 80 (3): 311–7. PMID 2399811.
- ↑ 12.0 12.1 Herscovici Z, Rappaport Z, Sulkes J, Danaila L, Rubin G (2004). "Natural history of conservatively treated meningiomas". Neurology. 63 (6): 1133–4. PMID 15452322.
- ↑ 13.0 13.1 Maclean J, Fersht N, Short S (2014). "Controversies in radiotherapy for meningioma". Clin Oncol (R Coll Radiol). 26 (1): 51–64. doi:10.1016/j.clon.2013.10.001. PMID 24207113.
- ↑ Ding D, Starke RM, Hantzmon J, Yen CP, Williams BJ, Sheehan JP (2013). "The role of radiosurgery in the management of WHO Grade II and III intracranial meningiomas". Neurosurg Focus. 35 (6): E16. doi:10.3171/2013.9.FOCUS13364. PMID 24289124.
- ↑ Simpson Grading System. Neurosurgic.com(2015) http://www.neurosurgic.com/index.php?option=com_content&view=article&id=846:simpson-grading-system-for-removal-of-meningeomas&catid=152:usefulinfo&Itemid=603 Accessed on September, 25 2015