Meningioma interventions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];

Overview

There are no recommended therapeutic interventions for the management of [disease name].

OR

[Name of intervention] is not the first-line treatment option for patients with [disease name]. [Name of intervention] is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy/surgery. [Name of intervention] is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of [name of intervention] depends on the stage of [disease or malignancy] at the time of diagnosis.

OR

[Name of intervention] is the mainstay of treatment for [disease or malignancy].

Indications

Observation/Expectant management

  • In some cases, a meningioma can be found incidentally when doing a work-up for something else. Expectant management can be pursued in incidental meningiomas without tissue edemas, vascular compromise,

Radiotherapy

  • The decision to treat with either surgery or radiotherapy depends on patient factors and the anatomical location of the tumor.[1]
  • For the treatment of smaller meningiomas, single fraction stereotactic radiosurgery may be used. Fractionated radiotherapy is used for larger volume tumors and/or those in contact with the optic chiasm/nerve.[1]
  • It can lead to symptom improvement with about less than 5% of patients presenting with worsened neurological deficit.[1]
  • In some cases, subtotal resection (a form of surgery) followed by radiotherapy is done. This provides only little advantage over treatment with radiotherapy alone.[1]
  • In situations where complete resection (with low morbidity) can be achieved, and/or to decompress tumors associated with pressure symptoms, surgery is highly appropriate.[1]
  • There could be a 20.5% risk for stroke associated with conventionally fractionated radiotherapy (radiation-based), with the average stroke developing about 5.6 years after the treatment.[2]

References

  1. 1.0 1.1 1.2 1.3 1.4 Smee R, Williams J, Kotevski D, Schneider M (2019). "Radiotherapy as a means of treating meningiomas". J Clin Neurosci. 61: 210–218. doi:10.1016/j.jocn.2018.10.006. PMID 30782319.
  2. McClelland Iii S, Mitin T, Kubicky CD, Jaboin JJ (2019). "Long-term stroke risk in meningioma patients treated with conventionally fractionated photon-based radiation therapy". J Radiosurg SBRT. 6 (1): 77–79. PMC 6355449. PMID 30775077.

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