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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