Meningiomas

Meningiomas, the most common intracranial tumors, are dura-based tumors that occur in middle-aged or older adults and have a predilection for women and African Americans. They are almost always benign, but atypical and malignant forms exist. The optimal treatment for symptomatic tumors is complete surgical resection when feasible. Tumors in poor locations can have a higher rate of morbidity and often can be only partially removed. Radiation therapy should be used to treat lesions that are partially removed and lesions of higher grade, despite complete removal. Small lesions may be amenable to radiosurgery, which may obviate surgery in high-risk patients. For lesions that recur or grow despite surgery and radiation, the only option is systemic chemotherapy. No agent is optimal, but hydroxyurea is used most often. Newer approaches such as the use of inhibitors of somatostatin receptors or signal transduction pathways are under investigation.