Well the meningioma is found typically surrounding the central nervous system. It is typically a
benign tumor but has a natural history where it can turn unfortunately malignant if untreated.
From the radiosurgical point of view, we are mainly interested in the intracranial lesions and
they usually originate from the surrounding tissue of the brain which is lining the cranial vault.
These lesions are, even though benign, posing a risk because with growth they inevitably will
cause cause compression of the brain and neurological impairment so the sooner they
are treated the better that is. The multiple modalities and the most minimally invasive
would be stereotactic radiosurgery. Nevertheless not all lesions are suitable for stereotactic
radiosurgery because they might be placed too close to very eloquent parts of the brain which
do not tolerate radiation treatment very well, for example the optic nerves or the optic chiasm,
and therefore a specialist opinion is definitely required to establish if that is suitable or not.
With meningiomas you can have a genetic predispositions for multiple lesions.
This can usually be genetically tested it is often associated to neurofibromatosis type 2 and
normally this is a very rare presentation often already presenting patients in childhood with
multiple lesions throughout the CNS, not only meningiomas but schwannomas as well, and that
is a very special indication if that happens and needs to have a special multidisciplinary input.
Typically meningiomas, sporadic meningioma, so single lesions are not genetically predisposed.
In the presentation of meningiomas, sometimes this is only a headache. Often they get identified even
nowadays incidentally because patients go and have MRI scans of their brain for other reasons
and these lesions are identified in such circumstances, interval imaging would be
the modality of choice to see how this lesion is behaving and if treatment is required at all,
the imaging technology has massively improved and on MRI scans we see in these lesions now
when they're even very very small and most likely not in any way symptomatic. On the other hand,
patients might present with impairment of cranial nerves. That might be hearing loss. That might be
tinnitus. This might be a visual impairment. It might be swallowing problems. So there is a
wide spectrum of presentations some patients present with seizures, so there is a very wide
spectrum and it is important that this is all evaluated in the specialist clinic and set up.
It depends on the age of the patient. It depends on the location of the tumor and the growth
pattern this tumor exhibits. So sometimes these lesions can be static for many many years or
even for decades and may not grow at all so it is a very individually tailored and neat
treatment pathway which each patient requires depending on their very personal circumstances.
It depends. It is either expectance, interval imaging on an annual- typically on an annual
basis because these tumors typically grow one to three millimeters per year and not more.
When they grow treatment itself consists of either surgical resection. That's the most
invasive way forward and sometimes and in many circumstances that might be the best way forward.
On the other hand, if the lesion is suitable for stereotactic radiosurgery and that is dependent on
location, on surrounding tissues and size, i.e. volume, then this minimal invasive technology
might be the most suitable way forward for a patient harbouring a growing meningioma and
for that it is important that these patients are all evaluated in a multidisciplinary setting and
to consider all these three options to tailor the treatment for each individual patient carefully.