Intracranial meningiomas: an overview of diagnosis and treatment

Meningiomas are extraaxial central nervous system tumors most often discovered in middle to late adult life, and are more often seen in women. Ninety percent of meningiomas are benign, 6% are atypical, and 2% are malignant. Most patients in whom a meningioma is diagnosed undergo resection to relieve neurological symptoms. Complete resection is often curative. For the majority of incompletely resected or recurrent tumors not previously irradiated, radiotherapy is administered. Radiotherapy may be administered as either conventional external-beam radiation therapy or stereotactically by linear accelerator, Leksell Gamma Knife, or Cyberknife radiosurgery. Advocates of stereo-tactic radiotherapy have suggested this therapy in lieu of surgery particularly in high-risk patients, those with meningiomas in eloquent or surgically inaccessible locations, and elderly patients. When the meningioma is unresectable or all other treatments (surgery and radiotherapy) have failed, hormonal therapy or chemotherapy may be considered. Notwithstanding limited data, hydroxyurea has been modestly successful in patients with recurrent meningiomas.