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--- neo_brain [2026/01/08 22:33] – [Meningiomas] gary1
+++ neo_brain [2026/07/17 07:00] (current) – [Meningiomas] gary1
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 =====Meningiomas=====
-  *tumours arising from arachnoidal cap cells in the meninges
+  ***see [[meningiomas]]**
-  *usually slow growing
-  *92% are benign ("Grade I"), although may recur after surgery but still have benign histology
-    * although usually benign a "petro-clival" meningioma being deep within the skull base near the brainstem is typically fatal without treatment due to its location and Rx can be challenging, often with poor outcomes
-  *are usually well-circumscribed, and takes on the form of the space it occupies
-  *accounts for 30% of adult brain tumours and affects ~1 in 1000 adults
-  *women 2x men (although malignant ones are more likely in men)
-  *becoming more likely with age, most are found in those over age 50yrs
-  *25% are in falx cerebri, 19% are in the convexity of the brain, 17% are on the sphenoid ridge, 9% are suprasellar, 8% are in post fossa, 8% are in olfactory groove
-  *~7% are atypical meningiomas ("Grade II") with mean survival of ~12 yrs
-  *2% are malignant anaplastic meningioma ("Grade III") which are aggressive with mean survival of ~3 yrs
-  *risk factors:
-    * most are sporadic rather than familial
-    * FH meningioma
-    * neurofibromatosis type 2 - 50% develop one or more meningiomas
-    * ionizing radiation - frequent dental xrays (esp. older higher dose ones);
-    * long-acting injectable contraceptive depot medroxyprogesterone acetate (Depo-Provera)
-    * high doses of cyproterone acetate
-  * clinical features:
-    * most are asymptomatic, esp. if < 2cm
-    * symptoms depend on the location and occur as a result of the tumor pressing on nearby tissue
-      * may cause focal seizures
-  * Mx:
-    * select asymptomatic cases can be Mx by watchful waiting and repeat scanning as over half have no growth on repeat scans and only 6% develop symptoms
-    * younger adults are more likely to have growth and should be considered for neurosurgical referral
-    * can usually be surgically resected if location is amenable to surgery but 6-9% have ongoing symptoms from either the tumour or the surgery
-    * if invasion of the adjacent bone occurs, total removal is nearly impossible
-    * transarterial embolization has become a standard procedure in preoperative management of meningiomas
-    * 10yr recurrence rates after surgery are quite high (based on Simpson grading of resection: 40% with subtotal resection, 29% with complete resection but no dura resected, 19% with dura resected as well)
 =====Gliomas=====