2019 Volume 28 Issue 8 Pages 462-469
A meningioma is the most common benign tumor in the central nervous system. Asymptomatic small (<2 cm) meningiomas should be treated conservatively, whereas symptomatic large (>3 cm) tumors and asymptomatic tumors with rapid growth must be removed surgically or treated with radiation therapy. During surgery, surgeons should determine the ideal dissection plane to prevent injury to surrounding structures. If the meningioma has a capsule, it should be removed with subcapsular dissection because there are no tumor cells inside the tumor capsule. Radiation therapy, particularly stereotactic radiosurgery (SRS), is a proven alternative to surgical removal for small benign meningiomas, and the outcomes of subtotal resection with adjuvant SRS are comparable with those of gross total resection. In addition, gross total resection is desirable for atypical and malignant meningiomas, and postoperative adjuvant radiation is necessary for subtotally resected atypical meningiomas and malignant (World Health Organization [WHO] grade Ⅲ) meningiomas in any Simpson grades. In elderly patients, the treatment strategy must be much more individualized depending not only on age but also on frailty assessed by the meningioma-specific scoring system (e. g., SKALE score). Recent molecular analyses have demonstrated that molecular classification is a predictor of postoperative progression, and it is a more precise predictor than the WHO histological grade. In the near future, molecular diagnosis may become essential, and it will bring a paradigm shift in the treatment of meningioma.
