Clinical Management of Supratentorial Non-Skull Base Meningiomas

SIMPLE SUMMARY: Meningiomas are the most-common primary central nervous system tumors. These tumors are most commonly supratentorial in location. The current clinical management ranges from observation to multimodality treatment including surgery and radiation therapy. Non-invasive imaging features can help predict progression when tumor tissue is not available, in turn influencing the approach to these tumors. In parallel, there is a growing understanding regarding characteristics that influence their growth rate. This derives in large part from molecular pathologic studies that shed light on the pathophysiology of disease. It is hoped that this will impact the clinical management, particularly with regard to the use of radiation and systemic therapies. ABSTRACT: Supratentorial non-skull base meningiomas are the most common primary central nervous system tumor subtype. An understanding of their pathophysiology, imaging characteristics, and clinical management options will prove of substantial value to the multi-disciplinary team which may be involved in their care. Extensive review of the broad literature on the topic is conducted. Narrowing the scope to meningiomas located in the supratentorial non-skull base anatomic location highlights nuances specific to this tumor subtype. Advances in our understanding of the natural history of the disease and how findings from both molecular pathology and neuroimaging have impacted our understanding are discussed. Clinical management and the rationale underlying specific approaches including observation, surgery, radiation, and investigational systemic therapies is covered in detail. Future directions for probable advances in the near and intermediate term are reviewed.