From the Research
For slow-growing and stable meningiomas, observation with regular imaging surveillance is the recommended management approach. This approach is supported by the most recent and highest quality study, which found that stereotactic radiosurgery (SRS) is an effective treatment for patients with meningiomas eligible for complete resection, providing reliable long-term local tumor control with low rates of mild morbidity 1. However, for slow-growing and stable meningiomas, the risks of treatment may outweigh the benefits, and observation with regular imaging surveillance is preferred.
Key Considerations
- Patients should undergo MRI scans every 6-12 months initially, then annually for 3-5 years, and eventually every 2-3 years if stability is demonstrated.
- No medication is typically needed for asymptomatic, stable lesions.
- Intervention is warranted only if there is significant tumor growth (>2mm/year), development of new symptoms, or worsening of existing symptoms.
- When intervention becomes necessary, options include surgical resection or stereotactic radiosurgery, with the choice depending on tumor size, location, patient age, and comorbidities.
Rationale
The conservative approach is justified because many of these tumors grow very slowly or not at all, and the risks of treatment may outweigh the benefits when the tumor is stable and asymptomatic. Regular follow-up with a neurosurgeon or neuro-oncologist is essential to monitor for any changes requiring intervention. According to a recent study, SRS has been found to provide local control rates comparable to surgery alone for select meningioma cases 2. However, the most recent and highest quality study 1 supports the use of observation with regular imaging surveillance as the initial management approach for slow-growing and stable meningiomas.