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Review
. 2021 Jun 29;13(13):3259.
doi: 10.3390/cancers13133259.

Brain Invasion in Meningioma-A Prognostic Potential Worth Exploring

Felix Behling  1   2 , Johann-Martin Hempel  2   3 , Jens Schittenhelm  2   4
Affiliations
Review

Brain Invasion in Meningioma-A Prognostic Potential Worth Exploring

Felix Behling et al. Cancers (Basel). .

Abstract

Most meningiomas are slow growing tumors arising from the arachnoid cap cells and can be cured by surgical resection or radiation therapy in selected cases. However, recurrent and aggressive cases are also quite common and challenging to treat due to no established treatment alternatives. Assessment of the risk of recurrence is therefore of utmost importance and several prognostic clinical and molecular markers have been established. Additionally, the identification of invasive growth of meningioma cells into CNS tissue was demonstrated to lead to a higher risk of recurrence and was therefore integrated into the WHO classification of CNS tumors. However, the evidence for its prognostic impact has been questioned in subsequent studies and its exclusion from the next WHO classification proposed. We were recently able to show the prognostic impact of CNS invasion in a large comprehensive retrospective meningioma cohort including other established prognostic factors. In this review we discuss the growing experiences that have been gained on this matter, with a focus on the currently nonuniform histopathological assessment, imaging characteristics and intraoperative sampling as well as the overall outlook on the future role of this potential prognostic factor.

Keywords: WHO classification for CNS tumors; brain invasion; invasive growth; meningioma; prognosis; recurrence.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Three meningiomas of the Tübingen Meningioma Cohort are shown as representative examples of MR-Imaging characteristics that have been associated with invasive growth (peritumoral edema (A); irregular contrast enhancement (B); irregular tumor shape (C)). In all three cases histopathological evidence of invasive growth into CNS parenchyma was detected.
Figure 2
Figure 2
Illustration of the area of interest for meningioma sampling regarding the detection of CNS invasion. Dotted lines represent contact of the meningioma surface with non-eloquent (green) and eloquent (red) parenchyma ((A): right frontal convexity meningioma; (B): left frontoparietal falcine meningioma; (C): right-sided sphenoid wing meningioma; (D): left temporo-parietal convexity meningioma; (E): olfactory groove meningioma; (F): ventral thoracic meningioma).
See this image and copyright information in PMC

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