Meningioma: An Overview of Epidemiology, Etiology, Molecular Characteristics, Clinical Features, Treatments and Future Directions
Christian Ogasawara B S1*, Brandon D. Philbrick B S2 and D Cory Adamson3,4
1University of Hawaii School of Medicine, Honolulu, HI, USA
2Emory University School of Medicine, Atlanta, GA, USA
3Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
4Department of Neurosurgery, Atlanta VA, Atlanta, GA, USA
Citation: Ogasawara BSC, Philbrick BSBD, Adamson DC (2021) Meningioma: An Overview of Epidemiology, Etiology, Molecular Characteristics, Clinical Features, Treatments and Future Directions. SciTech Central Neurology 2021.
Received: April 09, 2021 Accepted: April 13, 2021 Published: April 13, 2021
Abstract
Meningiomas are mostly benign tumors originating from meningothelial cells (MEC), that make up 37.6% of all primary CNS tumors. Meningiomas are classified into 15 subtypes across 3 grades according to the 2016 World Health Organization (WHO) guidelines with survival and recurrence rates worsening as their grade increases. Meningiomas are more common in females and the incidence rate increases with age. Ionizing radiation and specific molecular alterations, ranging from epigenetic to cytogenetic alterations, have been associated with meningioma development. Grade I meningiomas are most likely seen at the skull base where higher grade meningiomas are more likely found in the convexities. Meningioma presentations are often nonspecific and location dependent. Skull base meningiomas present more often with neurological deficits and non-skull base meningiomas are more likely to present with seizures. Initial diagnosis is based off of MRI or contrast-enhanced CT. For tumors that are small and asymptomatic, a wait-and-see approach is taken, while complete surgical excision is the optimal treatment for symptomatic meningiomas. Radiotherapy is often used for subtotal resection (STR) primary or recurrent grade I meningioma. Most strongly recommend postoperative radiotherapy for grade II gross total resection (GTR)/STR and grade III GTR/STR. While systemic therapy is still under investigation, it is reserved for meningiomas that are recurrent or progressive that no longer respond to surgery and radiotherapy. The 10-year overall survival rate of WHO grade I, II, and III tumors are 83.7%, 53%, and 0%, respectively. There are many clinical trials that are ongoing that are studying the effects of radiotherapy regimens, chemotherapy, and immunotherapy. With current imaging and histopathologic grading suffering from subjectivity and variability in diagnostic and prognostic power, the incorporation of genomic and molecular features may provide a better system for classification.
Keywords: Meningioma, Central nervous system, Tumor, Benign, Malignant
Abbreviations: MEC- Meningothelial cells, STR- Subtotal resection, GTR- Gross total resection, WHO-World Health Organization
