Though generally benign, meningiomas can be life threatening when the involve the base of the brain. Large tumors or growing tumors may require surgery to control.
The management of a patient with a meningioma begins with careful evaluation of the history and clinical findings. The physician needs to have a clear understanding of the symptoms and how they are affecting the patient's life. The potential impact of other medical problems is also required.
For many patients with a meningioma the only radiographic study needed is magnetic resonance imaging (MRI). If information is needed about bone detail, computed tomography (CT) is done. Angiography is indicated in those patients in whom embolization may be a consideration or when more information about the arterial supply or venous drainage is neededto plan the operation than can be gained from MRI or magnetic resonance angiography.
The treatment options of surgery, radiation therapy, a combination of the two, or observation with periodic scans and examinations are then evaluated. Patients and surgeons carefully weigh together the short- and long-term benefits and risks. In many patients an operation is clearly indicated because of increasing disability, radiographic documentation of a surgically treatable tumor, and an assessment that this treatment can be done with an acceptable risk. However, in some patients the management decision can be difficult because of minimal or nonprogressive symptoms, the indolent natural history of some meningiomas, the risks involved with treatment because of location or pathological anatomy, the development of new radiosurgery treatments, or the accidental finding of the tumor.