Intracerebral meningiomas

Opinion statement Meningiomas are extra-axial brain tumors of middle to late adult life, and they have a female predominance. Overall, 90% of meningiomas are benign, 6% are atypical, and 2% are malignant. Most patients diagnosed with a meningioma decide to have it removed surgically and are advised to do so based on their neurologic symptoms. Complete surgical resection is usually curative. For incompletely resected or recurrent tumors not previously irradiated, radiotherapy is administered. Radiotherapy may be administered as conventional external beam irradiation or stereotactically. Stereotactic radiotherapy, as linear accelerator or gamma-knife radiosurgery is increasingly used. Advocates of stereotactic radiotherapy have suggested this therapy in lieu of surgery particularly for poor surgical risk patients, patients with meningiomas in eloquent or surgically inaccessible locations, and patients of advanced age. When the meningioma is unresectable or all other treatments (surgery, radiotherapy) have failed, immunochemotherapy may be considered. Hydroxyurea, interferon-alpha, tamoxifen, and mifepristone have been modestly successful in patients with recurrent meningiomas, whereas cyclophosphamide, adriamycin, and vincristine, ifosfamide/mesna, or adriamycin/dacarbazine have been administered to patients with aggressive or malignant meningiomas.