Review of Treatment Options for Smaller Benign Cranial Meningiomas: Observation, Stereotactic Radiosurgery, and Rarely, Open Surgery

BACKGROUND: MR/CT documented smaller cranial meningiomas in asymptomatic patients are often followed for years without requiring any intervention. Only a subset of patients who become symptomatic attributed to significant tumor growth, edema and/or mass effect may require stereotactic radiosurgery (SRS), and rarely, open surgery. Clearly, the decision for choosing any treatment modality must be made on a case by case basis and include an analysis of risks vs. benefits to the individual patient. METHODS: Patients with smaller benign asymptomatic meningiomas are followed with sequential MR studies that typically document lack of tumor progression, edema, or mass effect. Those who become symptomatic with the typical triad (i.e. headaches, seizures, or visual loss) and other focal neurological deficits may warrant SRS, and only occasionally, open surgery. Surgery may indeed be warranted in the presence of certain mitigating factors, (e.g. young age, lesions located adjacent to by not yet invading critical structures etc.). RESULTS: This review focused largely on smaller benign asymptomatic meningiomas. The non-operative/ conservative management vs. use of SRS vs. open surgery in select cases are discussed, along with a review of the morbidity/mortality of the respective interventions. CONCLUSION: There are multiple treatment options for patients with smaller asymptomatic cranial meningiomas. SRS may be warranted for those who exhibit tumor growth, increasing edema, and/or mass effect. Only rarely is open operative intervention necessary; this must include consideration of other factors that may warrant early surgery. Notably, the 5-year survival rates for SRS ranged from 95.2% - 97%, while the 10-year survival rates varied from 88.6% - 94%.