Nonmalignant Brain Tumors

This article describes the diagnosis and management of meningioma, pituitary adenoma, craniopharyngioma, and glioneuronal tumors.

Both meningiomas and pituitary adenomas are common brain tumors. In many cases, these lesions are found incidentally on imaging when patients are being evaluated for a variety of symptoms and signs. While nonmalignant, these tumors are occasionally associated with significant morbidity due to location and resulting secondary symptoms. Rarely, these tumors can also transform into malignant variants. Surgical techniques allow for more complete resections with minimal complications. Significant progress is being made in understanding the molecular biology of meningioma, which may result in wider availability of targeted therapies, especially for patients who are not candidates for other therapeutic modalities. Medical therapies for secretory pituitary adenomas continue to evolve. Craniopharyngiomas are nonmalignant tumors associated with significant morbidity due to their location. Molecular subtypes exist and may respond to targeted agents. Glioneuronal tumors are low-grade neoplasms potentially cured by gross total resection; however, residual and recurrent disease may require additional therapy. Recent studies have identified potentially targetable molecular alterations in more than half of cases.

Meningiomas and pituitary adenomas are frequently encountered in neurologic practice, and familiarity with their presentation and management is essential for a practicing neurologist. Craniopharyngiomas, meningiomas, and glioneuronal tumors are characterized by a high frequency of potentially actionable genetic alterations, and targeted therapies may eventually supplement surgical therapy of these nonmalignant tumors.