The management of incidental meningioma: An unresolved clinical conundrum

The widespread availability and use of brain magnetic resonance imaging and computed tomography has led to an increase in the frequency of incidental meningioma diagnoses. Most incidental meningioma are small, demonstrate indolent behavior during follow-up, and do not require intervention. Occasionally, meningioma growth causes neurological deficits or seizures prompting surgical or radiation treatment. They may cause anxiety to the patient and present a management dilemma for the clinician. The questions for both patient and clinician are will the meningioma grow and cause symptoms such that it will require treatment within my lifetime? and will deferment of treatment result in greater treatment-related risks and lower chance of cure?. International consensus guidelines recommend regular imaging and clinical follow-up, but the duration is not specified. Upfront treatment with surgery or stereotactic radiosurgery/radiotherapy may be recommended but this is potentially an overtreatment, and its benefits must be balanced against the risk of related adverse events. Ideally, treatment should be stratified based on patient and tumor characteristics, but this is presently hindered by low-quality supporting evidence. This review discusses risk factors for meningioma growth, proposed management strategies, and ongoing research in the field.

Automated summary

The increased availability and use of brain imaging have led to more incidental diagnoses of meningioma. Most incidental meningiomas are small and do not require treatment, but in some cases, surgical or radiation treatment may be necessary due to growth or symptoms. There is a need for regular follow-up but the duration is not specified. Treatment options must be carefully considered due to potential risks and lack of sufficient evidence.