TRENDS IN THE MANAGEMENT OF INTRACRANIAL MENINGIOMA
Keywords:
intracranial meningioma; neurosurgery; stereotactic radiosurgery; radiotherapy; active surveillance; WHO 2021; molecular markers; prognosis; survivalAbstract
Introduction. Intracranial meningiomas are the most common primary brain tumors and exhibit substantial clinical and biological heterogeneity. Over the last two decades, management paradigms have shifted: alongside surgical resection, stereotactic radiosurgery, fractionated radiotherapy, and active surveillance have gained increasing importance, particularly for small asymptomatic lesions.
Materials and Methods. A retrospective analytical review of population-based cohorts and large oncologic registries was performed. Demographics, tumor characteristics (size, WHO grade), clinical status, treatment strategy (observation, surgery, radiotherapy, combined approaches), and survival-related factors were assessed using descriptive statistics, multivariable regression models, and survival analyses.
Results. The cohort was predominantly female, and most tumors were WHO grade I. Over time, an increase in active surveillance and a relative decrease in surgical treatment rates were observed, particularly among patients with small tumors. Surgery remained the primary modality for large and symptomatic lesions, whereas radiosurgery and adjuvant radiotherapy were applied selectively, mainly for challenging skull-base locations, subtotal resection, and WHO grade II–III tumors. Older age, higher comorbidity burden, larger tumor size, and higher grade were associated with worse outcomes.
Conclusion. Current intracranial meningioma management is increasingly driven by a personalized, multidisciplinary strategy integrating clinical, radiological, and molecular-genetic parameters (within the WHO 2021 framework) to optimize risk stratification, tailor surgical extent, and justify radiotherapy or surveillance.
References
Aljuboori, Z., et al. (2021). Trends in the management paradigms of intracranial meningioma. Journal of Neurological Surgery Part B, 82(6), 623–630.
Brastianos, P. K., et al. (2013). Genomic characterization of meningiomas. The New England Journal of Medicine, 368(3), 213–224.
Cushing, H., & Eisenhardt, L. (1938). Meningiomas: Their classification, regional behavior, life history, and surgical end results. Springfield: Charles C. Thomas.
Goldbrunner, R., et al. (2021). EANO guideline on the diagnosis and management of meningiomas. The Lancet Oncology, 22(11), e281–e292.
Louis, D. N., et al. (2021). The 2021 WHO classification of tumors of the central nervous system. Acta Neuropathologica, 142, 301–315.
Nassiri, F., et al. (2019). A clinicogenomic classification of meningiomas. Nature Genetics, 51, 431–440.
Rogers, L., et al. (2015). Radiation therapy for WHO grade II and III meningiomas. Journal of Neurosurgery, 122(1), 1–11.
Simpson, D. (1957). The recurrence of intracranial meningiomas after surgical treatment. Journal of Neurology, Neurosurgery, and Psychiatry, 20, 22–39.
Sughrue, M. E., et al. (2010). The natural history of incidental meningiomas. Neurosurgery, 67(4), 1060–1066.
Starke, R. M., et al. (2012). Gamma Knife radiosurgery for skull base meningiomas. Journal of Neurosurgery, 116(3), 588–597.
Ostrom, Q. T., et al. (2018). CBTRUS statistical report: Primary brain tumors. Neuro-Oncology, 20, iv1–iv86.
Hanft, S., & Canoll, P. (2017). Molecular biology of meningiomas. Neurosurgical Focus, 42(1), E2.
Jakobsen, J. B., et al. (2019). Proton therapy for meningiomas. Radiotherapy and Oncology, 141, 37–42.
Karsy, M., et al. (2019). Management of recurrent meningiomas. Journal of Neuro-Oncology, 141, 1–10.
Lee, J. H. (2010). Meningiomas: Diagnosis, treatment, and outcome. Springer.
Modha, A., & Gutin, P. H. (2005). Diagnosis and treatment of atypical and anaplastic meningiomas. Neurosurgery Clinics of North America, 16(3), 409–421.
Perry, A., & Louis, D. N. (2019). Molecular pathology of meningiomas. Brain Pathology, 29(3), 377–389.
Preusser, M., et al. (2018). Meningioma: Pathology, molecular genetics, and targeted therapies. Lancet Neurology, 17(12), 1061–1073.
Riemenschneider, M. J., et al. (2006). Genetic alterations in meningiomas. Acta Neuropathologica, 111, 349–361.
Wiemels, J., et al. (2010). Epidemiology and etiology of meningioma. Journal of Neuro-Oncology, 99(3), 307–314.
Rizaev Zh. A., Khaidarov N. K. Clinical , epidemiological and etiopathogenetic study of ischemic stroke // Journal of Neurology and Neurosurgical Research. – 2020. – T. 1. – No. 1.
Abdullayev Afzal, Kubayev Aziz, Rizayev Jasur . Excitability threshold in neuritis of the lower alveolar nerve. Journal of Biomedicine and Practice. 2022, vol. 7, issue 4, pp.238-245
Rizaev , Zh., Raimova , M., Boboev , K., & Abdullaeva, M. (2019). Parkinson's: classification, clinical picture and basics of treatment. Stomatologiya , 1(1(74), 64–67
Jawad, M., Uthirapathy, S., Altalbawy, F., Oghenemaro, E. F., Rizaev, J., Lal, M., ... & Al-Hamairy, A. K. (2024). Examining the role of antioxidant supplementation in mitigating oxidative stress markers in Alzheimer’s disease: a comprehensive review. Inflammopharmacology, 1-20.
