Meningioma Treatment Paradigms and Advances in Neurology

Meningiomas, the most common primary intracranial tumors, represent a significant challenge in neurology and neurosurgery. These tumors arise from the meninges, the protective membranes covering the brain and spinal cord, and account for approximately 40% of all primary brain tumors (Wang et al., 2024). The treatment strategies for meningiomas have evolved considerably over recent years, driven by advancements in imaging technologies, surgical techniques, and our understanding of the tumor biology.

Treatment Options

The treatment of meningiomas primarily involves surgical resection, particularly for symptomatic and growing tumors. Surgery is often the only curative option, especially for larger tumors or those causing significant mass effects. In cases where complete resection is not feasible due to the tumor’s location or associated risks, other treatment modalities may be employed. These include:

Stereotactic Radiosurgery (SRS): SRS is a non-invasive technique that delivers high doses of radiation precisely to the tumor, minimizing damage to surrounding healthy tissue. It is typically recommended for small, asymptomatic meningiomas or for patients who are not surgical candidates (Mei & Zhang, 2025).
Observation: For asymptomatic patients or those with small, non-growing tumors, a “watchful waiting” approach may be adopted. Regular imaging is performed to monitor for any changes in tumor size or symptoms (Nassiri et al., 2024).
Endovascular Embolization: This technique is used as an adjunct to surgery for tumors with a significant vascular supply, helping to reduce intraoperative bleeding and improve surgical outcomes (Wang et al., 2024).

Advances in Molecular Biology

Recent studies have highlighted the importance of molecular biomarkers in the management of meningiomas. These biomarkers can provide insights into the tumor’s behavior, potential aggressiveness, and response to treatment. The identification of specific genetic mutations, such as those in the AKT1 and NF2 genes, has led to a more nuanced understanding of meningioma biology, paving the way for targeted therapies (Nassiri et al., 2024).

Incidence and Risk Factors Associated with Meningiomas

The incidence of meningiomas has been on the rise, correlating with increased access to advanced neuroimaging techniques that facilitate earlier detection. According to recent data, the age-adjusted incidence rate of meningiomas is approximately 9.73 per 100,000 persons, with a notable increase in incidence observed among older populations (Wang et al., 2024).

Major Risk Factors

Several risk factors have been associated with the development of meningiomas, including:

Age and Gender: Meningiomas are more prevalent in women and typically occur in individuals aged 40 and older (Ostrom et al., 2023).
Radiation Exposure: A history of exposure to ionizing radiation, particularly in the head, significantly increases the risk of developing meningiomas (Nassiri et al., 2024).
Genetic Predisposition: Patients with neurofibromatosis type 2 (NF2) and those with germline mutations in genes such as MLLT10 have a higher risk of developing meningiomas (Wang et al., 2024).

Diagnostic Challenges and Imaging Techniques for Meningiomas

The diagnosis of meningiomas typically involves a combination of clinical evaluation and advanced imaging techniques. Magnetic resonance imaging (MRI) is the gold standard for assessing meningiomas, providing detailed images of the tumor’s size, location, and effect on surrounding structures. Computed tomography (CT) scans can also be useful, particularly for identifying calcifications within the tumor.

Imaging Techniques

MRI with Contrast: This technique enhances the visibility of meningiomas, allowing for better differentiation from surrounding brain tissue (Mei & Zhang, 2025).
CT Imaging: Useful in acute settings, CT can quickly identify large tumors or associated hemorrhages, although it is less sensitive than MRI for detecting small lesions (Nassiri et al., 2024).

Diagnostic Challenges

Despite advancements in imaging, challenges remain in distinguishing meningiomas from other intracranial masses, such as metastases and gliomas. The overlap in clinical presentation and imaging characteristics can complicate the diagnostic process. In some cases, biopsy may be necessary to confirm the diagnosis, particularly for atypical presentations (Wang et al., 2024).

Surgical Approaches and Innovations in Meningioma Resection

Surgical resection remains the first-line treatment for symptomatic meningiomas. The surgical approach is heavily influenced by tumor location, size, and the patient’s overall health.

Innovations in Surgical Techniques

Recent innovations in neurosurgery have enhanced the safety and efficacy of meningioma resection. These include:

Endoscopic Techniques: Minimally invasive endoscopic approaches allow for tumor resection with reduced recovery times and lower complication rates (Mei & Zhang, 2025).
Laser-Assisted Surgery: The use of laser technology during surgery can help minimize bleeding and improve precision in tumor dissection (Wang et al., 2024).
Neuro-navigation Systems: Advanced imaging and navigation systems allow for more accurate targeting of tumors, improving surgical outcomes (Nassiri et al., 2024).

Surgical Outcomes

Surgical outcomes for meningioma resection depend on several factors, including the tumor’s size, location, and the extent of resection achieved. In general, complete resection of benign meningiomas is associated with favorable long-term outcomes. However, tumors that are not completely resected or are of higher grade may require additional treatment, such as radiation therapy (Wang et al., 2024).

Prognostic Factors Influencing Meningioma Patient Outcomes

Multiple factors can influence the prognosis of meningioma patients, including:

Tumor Grade: Higher-grade meningiomas (WHO grade 2 and 3) are associated with a greater risk of recurrence and poorer outcomes compared to grade 1 tumors (Nassiri et al., 2024).
Extent of Resection: Complete surgical resection is crucial for achieving optimal outcomes. Incomplete resection is associated with higher rates of recurrence (Nassiri et al., 2024).
Patient Age and Health: Younger patients and those with fewer comorbidities tend to have better surgical outcomes (Wang et al., 2024).

Role of Molecular Biomarkers in Meningioma Management

The integration of molecular biomarkers into the management of meningiomas represents a significant advancement in the field. Molecular profiling can guide treatment decisions and prognostication.

Key Molecular Biomarkers

AKT1 Mutations: Associated with aggressive tumor behavior, AKT1 mutations can inform treatment strategies (Wang et al., 2024).
NF2 Gene Alterations: Loss of function in the NF2 gene is a common finding in meningiomas and is associated with the development of multiple tumors (Nassiri et al., 2024).
Methylation Patterns: Recent studies have suggested that DNA methylation patterns may serve as prognostic indicators for meningiomas, helping to stratify patients based on risk (Wang et al., 2024).

Conclusion

The landscape of meningioma management continues to evolve, driven by advances in surgical techniques, imaging technologies, and molecular biology. While surgical resection remains the cornerstone of treatment, the incorporation of novel therapeutic approaches and biomarkers into clinical practice holds promise for improving patient outcomes. Ongoing research is essential to further understand the complexities of meningioma biology and to refine treatment paradigms.

References

Mei, W., & Zhang, D. (2025). Unraveling Tumor-to-Tumor Metastasis: Insights into Pathogenesis, Diagnostic Challenges, and Treatment Modalities. https://doi.org/10.2147/BTT.S505950
Wang, J. Z., et al. (2024). Meningioma: International Consortium on Meningiomas consensus review on scientific advances and treatment paradigms for clinicians, researchers, and patients
Ostrom, Q. T., et al. (2023). The Central Brain Tumor Registry of the United States: Statistical Report. https://doi.org/10.1007/s11060-023-04482-5
Nassiri, F., et al. (2024). Meningioma: Molecular and Clinical Insights. https://doi.org/10.1007/s11060-023-04556-4