Intracranial meningiomas: diagnosis and treatment

Meningiomas are extra-axial CNS tumors which have a female predominance and occur in middle-to-late adult life. Most meningiomas (90%) are benign, 6% are atypical and a small proportion (2%) are malignant. Most patients diagnosed with a meningioma undergo surgical resection to relieve neurological symptoms. Complete surgical resection is often curative. For most incompletely resected or recurrent tumors not previously irradiated, radiotherapy is administered. Radiotherapy may be administered as either conventional external beam irradiation or stereotactically by linear accelerator, gamma knife or cyberknife radiosurgery. Advocates of stereotactic radiotherapy have suggested this therapy in lieu of surgery particularly in poor surgical risk patients, patients with meningiomas in eloquent or surgically inaccessible locations and in patients of advanced age. When the meningioma is unresectable or all other treatments (e.g., surgery and radiotherapy) have failed, hormonal chemotherapy may be considered. Notwithstanding limited data, hydroxyurea has been modestly successful in patients with recurrent meningiomas.