Last updated: January 8, 2021
Meningiomas are almost always benign, slow-growing brain tumors that arise from arachnoid cap cells of the arachnoid villi. As meningiomas may remain asymptomatic for long periods of time, they are often an incidental finding. Tumor compression can lead to a wide variety of neurological symptoms (i.e., headaches, seizures, paresthesias) that are generally specific to the structure(s) being compromised. Contrast imaging typically shows an enhanced round tumor with well-defined margins that often resembles a snowball. Management depends on the location and grade of the tumor, as well as patient-specific factors such as age, comorbidities, and accompanying symptoms. Treatment generally consists of surgical intervention, radiotherapy, or a combination of both. In some cases (e.g., asymptomatic elderly patients, or those with slow-growing meningiomas), a "watch and wait" approach with regular tumor monitoring may be safer than invasive therapy.
Meningiomas are a diverse group of brain tumors that arise from the arachnoid layer (specifically the arachnoid cap cells) and can therefore occur in any part of the CNS with a meningeal covering.
Most common benign primary brain tumor in adults 
Sex: ♀ > ♂ (2:1) 
Age: most common in patients > 65 years of age 
Epidemiological data refers to the US, unless otherwise specified.
General clinical features 
Surgical resection: first-line treatment 
- Preoperative embolization in the case of highly vascular tumors 
Skull base meningiomas have a high recurrence risk . 
Active surveillance: consider in a slow-growing asymptomatic tumor in an elderly patient 
- WHO grade I meningiomas: good prognosis, with a 5-year recurrence rate of 7–23% after resection 
- WHO grade II and III meningiomas: poor prognosis, with a 5-year recurrence rate of ∼ 50% and ∼ 75% respectively after resection 
|Meningioma recurrence rate based on the extent of tumor resection |
| Simpson grade 
|| Extent of tumor resection 
|| Recurrence rate after 10 years 
|Grade I || |
- Complete tumor resection
- Resection of the underlying dura and abnormal bone
|Grade II || |
- Complete tumor resection
- Cauterization of the dural attachment
|Grade III || |
- Complete tumor resection only
|Grade IV ||
|Grade V ||
MIB-1 index: an indirect measure of the rate of tumor growth 
Norden AD, Drappatz J, Wen PY. Advances in meningioma therapy. Curr Neurol Neurosci Rep. 2009; 9
Ostrom QT, Gittleman H, Fulop J, et al. CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2008-2012. Neuro Oncol. 2015; 17
(suppl 4): p.iv1-iv62.
doi: 10.1093/neuonc/nov189 . | Open in Read by QxMD
Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma.. J Neurooncol. 2010; 99
doi: 10.1007/s11060-010-0386-3 . | Open in Read by QxMD
Holleczek B, Zampella D, Urbschat S, et al. Incidence, mortality and outcome of meningiomas: A population-based study from Germany. Cancer Epidemiology. 2019; 62
doi: 10.1016/j.canep.2019.07.001 . | Open in Read by QxMD
Perry A. Meningiomas.
: p. 185-217
Patient Information: Meningiomas.
Updated: June 1, 2012.
Accessed: January 18, 2017.
Kim JH, Lee SH, Rhee CH, Park SY, Lee JH. Loss of heterozygosity on chromosome 22q and 17p correlates with aggressiveness of meningiomas. J Neurooncol. 1998; 40
Kazemi NJ, Kaye AH. Convexity Meningiomas.
: p. 301-307
Morokoff AP, Zauberman J, Black PM. SURGERY FOR CONVEXITY MENINGIOMAS. Neurosurgery. 2008; 63
doi: 10.1227/01.neu.0000310692.80289.28 . | Open in Read by QxMD
Elzarief AA, Ibrahim MF. Long-term follow-up of motor function deterioration following microsurgical resection of middle third parasagittal and falx meningioma. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2018; 54
doi: 10.1186/s41983-018-0013-3 . | Open in Read by QxMD
Del Toro E, Risbud A, Khosravani N, Vengerovich G, Archilla A. Sphenoid Wing Meningioma Presenting as Sudden Sensorineural Hearing Loss: A Case Report and Literature Review. Ear, Nose & Throat Journal. 2020
doi: 10.1177/0145561320905731 . | Open in Read by QxMD
Bos D, Poels MMF, Adams HHH, et al. Prevalence, Clinical Management, and Natural Course of Incidental Findings on Brain MR Images: The Population-based Rotterdam Scan Study. Radiology. 2016; 281
doi: 10.1148/radiol.2016160218 . | Open in Read by QxMD
Nakamura M, Struck M, Roser F, Vorkapic P, Samii M. Olfactory Groove Meningiomas: Clinical Outcome and Recurrence Rates after Tumor Removal Through the Frontolateral and Bifrontal Approach. Neurosurgery. 2007; 60
doi: 10.1227/01.neu.0000255453.20602.80 . | Open in Read by QxMD
Mostofi K. Foramen Magnum Meningioma: Some Anatomical and Surgical Remarks through Five Cases. Asian Spine Journal. 2015; 9
doi: 10.4184/asj.2015.9.1.54 . | Open in Read by QxMD
Ben Nsir A, Boughamoura M, Mahmoudi H, Kilani M, Hattab N. Uncommon Progression of an Extradural Spinal Meningioma. Case Reports in Surgery. 2014; 2014
doi: 10.1155/2014/630876 . | Open in Read by QxMD
Watts J, Box G, Galvin A, Brotchie P, Trost N, Sutherland T. Magnetic resonance imaging of meningiomas: a pictorial review.. Insights into imaging. 2014; 5
doi: 10.1007/s13244-013-0302-4 . | Open in Read by QxMD
Kunimatsu A, Kunimatsu N, Kamiya K, Katsura M, Mori H, Ohtomo K. Variants of meningiomas: a review of imaging findings and clinical features. Japanese Journal of Radiology. 2016; 34
doi: 10.1007/s11604-016-0550-6 . | Open in Read by QxMD
Yamaguchi S, Takeda M, Takahashi T, et al. Ginkgo leaf sign: a highly predictive imaging feature of spinal meningioma. Journal of Neurosurgery: Spine. 2015; 23
doi: 10.3171/2015.3.spine1598 . | Open in Read by QxMD
Lyndon D, Lansley JA, Evanson J, Krishnan AS. Dural masses: meningiomas and their mimics.. Insights into imaging. 2019; 10
doi: 10.1186/s13244-019-0697-7 . | Open in Read by QxMD
Accessed: January 7, 2021.
Huang S, Chen L, Mao Y, Tong H. Primary pulmonary meningioma. Medicine. 2017; 96
doi: 10.1097/md.0000000000006474 . | Open in Read by QxMD
Buerki RA, Horbinski CM, Kruser T, Horowitz PM, James CD, Lukas RV. An overview of meningiomas. Future Oncology. 2018; 14
doi: 10.2217/fon-2018-0006 . | Open in Read by QxMD
Martin AJ, Cha S, Higashida RT, et al. Assessment of Vasculature of Meningiomas and the Effects of Embolization with Intra-arterial MR Perfusion Imaging: A Feasibility Study. American Journal of Neuroradiology. 2007; 28
doi: 10.3174/ajnr.a0647 . | Open in Read by QxMD
Mendenhall WM, Friedman WA, Amdur RJ, Foote KD. Management of benign skull base meningiomas: a review.. Skull Base. 2004; 14
(1): p.53-60; discussion 61.
doi: 10.1055/s-2004-821364 . | Open in Read by QxMD
Kondziolka D, Levy EI, Niranjan A, Flickinger JC, Lunsford LD. Long-term outcomes after meningioma radiosurgery: physician and patient perspectives. J Neurosurg. 1999; 91
Violaris K, Katsarides V, Sakellariou P. The Recurrence Rate in Meningiomas: Analysis of Tumor Location, Histological Grading, and Extent of Resection. Open Journal of Modern Neurosurgery. 2012; 2
doi: 10.4236/ojmn.2012.21002 . | Open in Read by QxMD
Nanda A, Bir SC, Maiti TK, Konar SK, Missios S, Guthikonda B. Relevance of Simpson grading system and recurrence-free survival after surgery for World Health Organization Grade I meningioma. J Neurosurg. 2017; 126
doi: 10.3171/2016.1.jns151842 . | Open in Read by QxMD
Liu N, Song S-Y, Jiang J-B, Wang T-J, Yan C-X. The prognostic role of Ki-67/MIB-1 in meningioma. Medicine. 2020; 99
doi: 10.1097/md.0000000000018644 . | Open in Read by QxMD
Abry E, Thomassen IØ, Salvesen ØO, Torp SH. The significance of Ki-67/MIB-1 labeling index in human meningiomas: A literature study. Pathology - Research and Practice. 2010; 206
doi: 10.1016/j.prp.2010.09.002 . | Open in Read by QxMD