The Initial Evaluation and Surveillance of Meningiomas

Meningiomas are the most common intracranial tumor and are categorized into WHO grades I, II, and III based upon histopathological features. The initial clinical evaluation of a patient with a suspected meningioma should include neuroimaging, ideally with MRI. Some slow-growing, presumed meningiomas are safely monitored with only surveillance imaging. The gold standard for diagnosis is with histopathology from tissue obtained during surgery. The recommended treatment and surveillance imaging intervals thereafter are generally based on the WHO grade. For patients with grade I meningiomas, suggested surveillance imaging is at 3, 6, and 12 months postoperatively, with continued intervals of 6–12 months for at least 5 years. Surveillance imaging for grade II meningiomas is suggested to be at least as frequent as grade I tumors, or more frequent, as clinically indicated. Surveillance of grade III meningiomas should be tailored to the patient, but a continued imaging interval of every 3–6 months is suggested. Survival of patients with meningiomas is largely dependent on grade, with higher-grade tumors being associated with earlier and more frequent recurrences as well as shorter survivals.