Interdisciplinary Therapeutic Approaches to Atypical and Malignant Meningiomas

SIMPLE SUMMARY: Recent advances in diagnostics and adjuvant therapy regarding meningiomas have called into question the oncological relevance of gross total removal. Some authors see the Simpson grading as rather obsolete and adopt a more conservative treatment. In this narrative review, we discuss the significance of the degree of resection of aggressive meningiomas in terms of oncological profit and postoperative functional outcome according to the most recent studies. ABSTRACT: Meningiomas have the highest incidence among brain tumors. In contrast to benign tumors that constitute the majority of this tumor entity, the treatment of aggressive meningiomas (WHO Grade 2 and 3) is more challenging, requiring gross total removal of the tumor and the affected dura and adjuvant radiotherapy. Sometimes the location and/or the configuration of the tumor do not favor radical surgical resection without endangering the patient’s clinical condition after surgery and pharmacological therapy has, until now, not been proven to be a reliable alternative. Discussion: In this narrative review, we discuss the current literature with respect to the management of meningiomas, discussing the importance of the grade of resection in the overall prognosis of the patient and in the planning of adjuvant therapy. Conclusions: According to the location and size of the tumor, radical resection should be taken into consideration. In patients with aggressive meningiomas, adjuvant radiotherapy should be performed after surgery. In cases of skull base meningiomas, a maximal, though safe, resection should take place before adjuvant therapy. An interdisciplinary approach is beneficial for patients with primary or recurrent meningioma.