Treatment of Torcular Meningioma

Diagnostic Evaluation

MRI with contrast is the gold standard for evaluating torcular meningiomas, revealing homogeneous dural-based enhancement, dural tail, and relationship to venous structures 1
CT scan provides complementary information, particularly for calcified meningiomas, as it better visualizes calcifications that may not be clearly seen on MRI 2
Somatostatin receptor (SSTR) PET imaging should be considered when tumor extension is unclear or for differentiation between recurrence and post-treatment changes 1

Complete surgical resection including dural attachment is the optimal treatment when feasible 1, 2
Modern surgical techniques including image-guided surgery (frameless stereotaxy) improve precision and may reduce surgical side effects 1

Stereotactic radiosurgery (SRS) is effective for residual or recurrent meningiomas, particularly those <3 cm in diameter 3, 4
For larger meningiomas or those with pre-existing edema, fractionated stereotactic radiotherapy (SRT) may be preferred 2
External beam radiation therapy (EBRT) is indicated for WHO grade 3 (malignant) meningiomas after surgery and for subtotally resected WHO grade 2 (atypical) meningiomas 1

Blood loss can be significant during surgery, particularly in patients with smaller blood volumes 2
Post-operative swelling may occur and should be managed with high-dose steroids, head elevation, and close neurological monitoring 2

Small (<3 cm) asymptomatic torcular meningiomas without significant mass effect may be observed with regular MRI surveillance 1
Symptomatic torcular meningiomas or those showing growth should undergo surgical intervention when feasible 1
For tumors with extensive venous sinus involvement where complete resection carries high risk, a combination of subtotal resection followed by SRS/SRT is recommended 3
For WHO grade 2/3 tumors or incomplete resection, adjuvant radiation therapy is strongly recommended 1

MRI without and with contrast every 6-12 months is recommended for follow-up 1
After achieving stable disease status (typically after 5-10 years), follow-up intervals can be extended 2
Clinical follow-up should include routine neurological examinations and assessment for signs of increased intracranial pressure 5