Meningioma

MRI with gadolinium contrast is the standard for diagnosing meningioma. These tumors characteristically appear as sharply defined, homogeneously enhancing masses arising from the dura. CT scanning complements MRI by demonstrating calcification within the tumor and providing detailed assessment of bone involvement, which is important for surgical planning. CT angiography or formal cerebral angiography may be used preoperatively to assess the tumor's blood supply and relationship to major venous sinuses.

The treatment strategy depends on the tumor's size, location, grade, growth rate, and the patient's age and neurological status. Active surveillance — periodic MRI monitoring without immediate intervention — is appropriate for small, asymptomatic grade 1 meningiomas, particularly in older patients, where the risk of continued observation is often lower than the risk of surgery. Many conservatively observed meningiomas remain stable or grow very slowly over years of follow-up.

Surgical resection remains the primary treatment for meningiomas that are symptomatic, growing, or in locations where further growth poses unacceptable neurological risk. The degree of surgical resection is graded using the Simpson scale (grades 1 through 5), with more complete removal associated with lower recurrence rates. Complete resection of grade 1 meningioma is considered potentially curative, though the dural origin site and any involved bone must also be addressed. Stereotactic radiosurgery (Gamma Knife) is an effective alternative to surgery for meningiomas smaller than approximately three centimeters that are not causing significant mass effect, offering high tumor control rates in carefully selected patients. Adjuvant radiation therapy is typically recommended following resection of grade 2 and grade 3 meningiomas.