Identification and Management of Aggressive Meningiomas

Abstract

Meningiomas are common primary central nervous system tumors derived from the meninges, with management most frequently entailing serial monitoring or a combination of surgery and/or radiation therapy. Although often considered benign lesions, meningiomas can not only be surgically inaccessible but also exhibit aggressive growth and recurrence. In such cases, adjuvant radiation and systemic therapy may be required for tumor control. In this review, we briefly describe the current WHO grading scale for meningioma and provide demonstrative cases of treatment-resistant meningiomas. We also summarize frequently observed molecular abnormalities and their correlation with intracranial location and recurrence rate. We then describe how genetic and epigenetic features might supplement or even replace histopathologic features for improved identification of aggressive lesions. Finally, we describe the role of surgery, radiotherapy, and ongoing systemic therapy as well as precision medicine clinical trials for the treatment of recurrent meningioma.

Keywords: CNS tumors; chemotherapy; immunotherapy; meningioma; radiation therapy; skull base surgery.

Figure 1

Common intracranial locations of meningiomas highlighted in this review with associated DNA driver mutations or chromosomal loss (6, 14, 23, 24). Locations correlated to a generalized scale ranging from less (green) to more (red) complicated to resect and manage. Meningioma locations not pictured include clinoid, foramen magnum, cavernous sinus, suprasellar, and tentorial.