Meningioma
Meningioma is a usually benign tumor arising from the arachnoid cells of the membranes (meninges) covering the brain and spinal cord. It is the most common extra-axial intracranial mass in adults and accounts for roughly one third of primary brain tumors. The World Health Organization (WHO) grades it as grade 1, 2 or 3.
Përditësimi i fundit: 2026-06-06
Definition
Meningioma develops from the arachnoid cap cells of the meninges that surround the brain and spinal cord. It arises from outside the brain tissue (extra-axial) and forms a broad-based attachment to the dura. The large majority (about 80-85%) are benign (WHO grade 1); a smaller proportion show atypical (grade 2) or malignant (grade 3) behavior.
Epidemiology and Risk Factors
Meningioma accounts for roughly 37-38% of primary intracranial tumors and its incidence rises with age, with a mean age at diagnosis in the mid-60s. It is about 2-2.5 times more common in women than men, and hormonal influences (progesterone receptor) may contribute; some tumors can grow rapidly during pregnancy. Known risk factors include a history of ionizing radiation to the head and neurofibromatosis type 2 (NF2). With the widespread use of magnetic resonance imaging (MRI), many meningiomas are now found incidentally without symptoms.
Symptoms
Because meningiomas grow slowly, symptoms are usually insidious and progressive and depend on tumor location. Common features include site-specific headache, epileptic seizures (especially with convexity tumors), limb weakness or sensory loss in the area compressed by the tumor, visual problems, loss of smell, and personality or cognitive changes with frontal lobe compression. A substantial proportion of cases are asymptomatic.
Diagnosis
Contrast-enhanced brain MRI is the gold standard for diagnosis. A meningioma typically appears as a broad-based, homogeneously and strongly enhancing extra-axial mass; thickening and enhancement of the adjacent dura (the dural tail sign) is characteristic. Computed tomography (CT) demonstrates calcification and bone thickening (hyperostosis). Definitive diagnosis is made by pathological examination of tissue obtained at surgery. Since the 2021 WHO classification, molecular tests (TERT promoter mutation, CDKN2A/B deletion) have become part of routine assessment.
Grading (2021 WHO CNS5)
The 2021 WHO classification of central nervous system tumors (CNS5) integrates molecular profiling with histological criteria. Grade 1 (benign) tumors grow slowly with a low recurrence risk. Grade 2 (atypical) tumors show increased mitotic activity, brain invasion or specific histological features and carry a higher recurrence risk. Grade 3 (anaplastic/malignant) tumors show marked anaplasia. Importantly, even when histology appears benign, the presence of a TERT promoter mutation or homozygous CDKN2A/B deletion classifies the tumor as grade 3.
Treatment Options
Treatment is individualized according to tumor size, location, symptoms, grade and the patient's general condition. For asymptomatic, small tumors—particularly in older patients—active surveillance (watch-and-wait) with periodic MRI is an appropriate option. For symptomatic, growing or higher-grade tumors, the goal is the widest safe surgical resection; the extent of resection has traditionally been graded by the Simpson classification. Stereotactic radiosurgery (Gamma Knife, CyberKnife) is effective for small to moderate, deep or surgically high-risk tumors. Fractionated radiotherapy may follow surgery for high-grade or partially resected tumors. For recurrent disease, targeted agents are under investigation.
Prognosis
For benign (grade 1) meningiomas, long-term outcomes after complete resection are favorable with a low recurrence risk. Atypical and malignant tumors carry a markedly higher recurrence risk. Today, molecular profile (TERT, CDKN2A/B) can be a stronger predictor of recurrence than histological grade alone. Care is planned by a multidisciplinary team; outcomes vary from patient to patient and no outcome can be guaranteed.
Burimet
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:803-819.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:1427-1447.
- DeMonte F, McDermott MW, Al-Mefty O, eds. Al-Mefty's Meningiomas. 2nd ed. Thieme; 2011:52-67.
- Louis DN, et al. The 2021 WHO Classification of Tumors of the Central Nervous System. Neuro Oncol. 2021.
- Goldbrunner R, et al. EANO guideline on the diagnosis and management of meningiomas. Neuro Oncol. 2021.
Ky artikull ka karakter të përgjithshëm informues dhe nuk zëvendëson vizitën mjekësore. Vendimet për diagnozën dhe trajtimin janë individuale.