Management of Slow-Growing Meningiomas

Evaluation and Surveillance

The British journal of neurosurgery recommends that a slow and moderate growth of a meningioma, such as from 8x8x10mm to 9x9x11mm in 4 years, is compatible with the typical behavior of benign meningiomas 1
The World Health Organization (WHO) grade 1 meningiomas, which are the most common, should be surveilled with MRI every 6 to 12 months, as recommended by the Clinical Cancer Research guidelines 2, 3, 4
After a period of stability of 5 years, the intervals between imaging exams can be prolonged, according to the Clinical Cancer Research guidelines 2, 4

The Clinical Cancer Research guidelines indicate that surgical or radiotherapeutic intervention would be necessary only if significant growth is observed during follow-up, or if neurological symptoms appear, or if parenchymal edema develops, or if seizures or increased intracranial pressure occur 4

The British journal of neurosurgery recommends that complete surgical resection is the treatment of choice for symptomatic meningiomas 1
The Praxis Medical Insights guidelines suggest that stereotactic radiosurgery (SRS) is an option for small residual or recurrent tumors, with 5-year progression-free survival rates of 86% to 99% 2
The Praxis Medical Insights guidelines also recommend that fractionated stereotactic radiotherapy (SRT) may be considered for larger tumors or those close to critical structures 2, 3