Meningioma natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Ifeoma Odukwe, M.D. [2] Haytham Allaham, M.D. [3]

## Overview

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The incidence of meningioma increases with advancing age, with the median age of diagnosis being about 65 years. There are some factors associated with faster progression of the tumor, they include absence of calcification, age 60 or younger, and intial tumor diameter greater than 25mm. Meningiomas can grow in a linear or volumetric fashion. They can grow anywhere in the central nervous system containing arachnoid membrane. If left untreated, patients with meningioma may progress to developing morning headaches, focal neurological deficits, edema surrounding the tumor, cranial nerve palsies, and more. Prognosis is generally good, and the survival rate of patients with meningioma mainly depends on the grade and the extent of resection of the tumor.

## Natural History, Complications, and Prognosis

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* The median age at diagnosis of meningioma is about 65 years, with incidence increasing with advancing age.[1]
* Absence of calcification, age 60 or younger, and initial tumor diameter of greater than 25 mm are among the factors associated with a short time to progression.[2]
* Linear growth may be seen in 44% of the patients, while volumetric growth may be seen in 74%.[2]
* A higher annual growth rate may be seen in patients with an initial tumor diameter of greater than 25 mm, MR imaging T2 signal hyperintensity, patients presenting with symptoms and edema, and male patients.[2]
* Meningomas are usually single but can be multiple in about 1 - 10% of the patients. Multiple meningiomas are usually seen in patients with neurofibromatosis.[3][4]
* The rate of growth in patients with multiple meningiomas is similar to those with solitary meningiomas.
* Meningiomas can grow anywhere in the central nervous system containing arachnoid membrane. For example, between the brain and the cranium, in the ventricles, down the spinal canal.[5]

### Complications

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* Common complications of meningioma include:[6][7]

* Increased intracranial pressure
* Cranial nerve palsies
* Hydrocephalus
* Peritumoral brain edema
* Stroke: Due to occlusion of the internal carotid artery. This can be seen in meningiomas located at the skull base

### Prognosis

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* The prognosis of meningioma is usually determined by 2 of the most important factors which are the extent of the resection and the histological grade of the tumor.[8]
* The 5 year estimated survival for benign tumors is 85.6%, 82.3% for borderline malignant tumors, and 66% for malignant tumors. A poorer survival rate may be seen in patients of advanced age, male patients, black race, malignant tumors, and patients with no initial treatment.[1]
* Patients with atypical meningioma have a higher overall recurrence-free survival rate than those with anaplastic meningioma.[9]
* The prognostic factors in patients with anaplastic meningioma include brain invasion, adjuvant radiotherapy, malignant progression, p53 over expression, and extent of resection.[9]
* There may be a chance of recurrence of higher grade meningiomas even if they received gross-total resection or not.[8]
* Grade 1 meningioma is associated with a median survival of approximately 10 years.[10]
* Grade 3 meningioma is associated with a median survival of approximately 2.7 years.
* For classic tumors, the 5 year recurrence rate is about 12%, and they are not associated with a decreased overall length of survival. Unlike atypical tumors which have a 41% recurrence rate and decreased overall length of survival.[8]
* Progesterone positive tumors tend to have lower proliferation indices resulting in a better prognosis than those that are progesterone receptor negative.[8]
* The tumors that are positive for estrogen receptors and those negative for both estrogen and progesterone receptors have an increased potential for aggressive clinical behavior, progression and recurrence.[11]

## References

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1. ↑ 1.0 1.1 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. PMC 5549267. PMID 25872752.CS1 maint: Multiple names: authors list (link)
2. ↑ 2.0 2.1 2.2 Oya S, Kim SH, Sade B, Lee JH (2011). "The natural history of intracranial meningiomas". J Neurosurg. 114 (5): 1250–6. doi:10.3171/2010.12.JNS101623. PMID 21250802.CS1 maint: Multiple names: authors list (link)
3. ↑ Wong RH, Wong AK, Vick N, Farhat HI (2013). "Natural history of multiple meningiomas". Surg Neurol Int. 4: 71. doi:10.4103/2152-7806.112617. PMC 3683641. PMID 23776757.CS1 maint: Multiple names: authors list (link)
4. ↑ Sheehy JP, Crockard HA (1983). "Multiple meningiomas: a long-term review". J Neurosurg. 59 (1): 1–5. doi:10.3171/jns.1983.59.1.0001. PMID 6864264.
5. ↑ Sumkovski R, Micunovic M, Kocevski I, Ilievski B, Petrov I (2019). "Surgical Treatment of Meningiomas - Outcome Associated With Type of Resection, Recurrence, Karnofsky Performance Score, Mitotic Count". Open Access Maced J Med Sci. 7 (1): 56–64. doi:10.3889/oamjms.2018.503. PMC 6352459. PMID 30740161.CS1 maint: Multiple names: authors list (link)
6. ↑ Shibuya M (2015). "Pathology and molecular genetics of meningioma: recent advances". Neurol Med Chir (Tokyo). 55 (1): 14–27. doi:10.2176/nmc.ra.2014-0233. PMC 4533397. PMID 25744347.
7. ↑ Komotar, R J (2003). "Meningioma presenting as stroke: report of two cases and estimation of incidence". Journal of Neurology, Neurosurgery & Psychiatry. 74 (1): 136–137. doi:10.1136/jnnp.74.1.136. ISSN 0022-3050.
8. ↑ 8.0 8.1 8.2 8.3 Commins, Deborah L.; Atkinson, Roscoe D.; Burnett, Margaret E. (2007). "Review of meningioma histopathology". Neurosurgical Focus. 23 (4): E3. doi:10.3171/FOC-07/10/E3. ISSN 1092-0684.
9. ↑ 9.0 9.1 Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW (2008). "Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features". J Neurol Neurosurg Psychiatry. 79 (5): 574–80. doi:10.1136/jnnp.2007.121582. PMID 17766430.CS1 maint: Multiple names: authors list (link)
10. ↑ Fathi AR, Roelcke U (2013). "Meningioma". Curr Neurol Neurosci Rep. 13 (4): 337. doi:10.1007/s11910-013-0337-4. PMID 23463172.
11. ↑ Pravdenkova, Svetlana; Al-Mefty, Ossama; Sawyer, Jeffrey; Husain, Muhammad (2006). "Progesterone and estrogen receptors: opposing prognostic indicators in meningiomas". Journal of Neurosurgery. 105 (2): 163–173. doi:10.3171/jns.2006.105.2.163. ISSN 0022-3085.

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