Meningioma

Meningiomas are tumours arising from the meninges, the membranous layers surrounding the central nervous system. These tumours are usually  benign, many of them are producing no symptoms throughout a patient's life, so that they require no treatment.

 

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Different Types of Meningioma

  • meningothelial meningioma (WHO grade I)
  • fibroblastic meningioma (WHO grade I)
  • transitional (mixed) meningioma (WHO grade I)
  • psammomatous meningioma (WHO grade I)
  • angiomatous meningioma (WHO grade I
  • microcystic meningioma (WHO grade I)
  • secretory meningioma (WHO grade I)
  • lymphoplasmacyte-rich meningioma (WHO grade I)
  • metaplastic meningioma (WHO grade I)
  • chordoid meningioma (WHO grade II)
  • clear cell meningioma (WHO grade II)
  • atypical meningioma (WHO grade II)
  • papillary meningioma (WHO grade II, III)
  • rhabdoid meningioma (WHO grade III)
  • anaplastic meningioma (WHO grade III)

 

Histology of Meningeoma

  • slowly growing, benign meningeoma (WHO-grade I)
  • atypical meningeoma, tending to relapses (WHO-grade II)
  • fast growing, anaplastic meningeoma (WHO-grade III)

 

Epidemiology of Meningeoma

 

  • 85% of all meningeoma are benign, 8-10% are atypical and 2-5% anaplastic
  • average age between 50 and 60
  • women are a little more often affected

 

Symptoms of Meningeoma

 

  • depending on location and the compression which is connected to it
  • signs of cerebral pressure (e.g. headache)
  • neurological deficits (e.g. impaired vision, uncertain gait)
  • epilepsy
  • often patients don´t feel any symptoms

 

Diagnosing Meningeoma

 

  • diagnosis with CT and MRI
  • if necessary MR-angiography, functional MRI, MR-spectroscopy, PET
  • clearly defined lesion with perifocal edema
  • intensive, homogenous enhancement of contrast agent
  • tends to calcification
  • 9% oft he patients have more than one meningeoma
  • 27% of meningeoma feature genetic modifications (monosomy 22)
  • occurs more often in patients with neurofibromatosis type II and preceding radiotherapy
  • possibly faster growth in pregnancy

 

Therapy of Meningeoma

 

  • if possible, complete surgical removal of brain tumour
  • preoperative embolisation possible  in vascular-rich tumours
  • treatment of anaplastic menigeoma with additional radiotherapy
  • small, asymptomatic meningeomas therapy is not always necessary

 

Therapy of Recurrent Meningeoma

 

  • re-operation
  • (second) irradiation
  • chemotherapy, e.g. with hydroxyurea
  • experimental therapy, e.g. with antiangiogenic approaches

 

Aftercare of Meningeoma

 

  • check-up every 6 to 12 months
  • if necessary ophthalmological, neurological and endocrinological examinations

 

Course of Meningeoma

 

  • slow, extrusive growth with branches in dura mater

 

Prognosis of Menigeoma 

 

  • complete surgical removal of benign meningeoma i soften equivalent to a cure
  • frequency of recurrences of WHO-grade I: 7-20%
  • frequency of recurrences of WHO-grade II: 30-40%
  • frequency of recurrences of WHO-grade III: 50-80%

 

 

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