Islim Abdurrahman I, Millward Christopher P, Mills Samantha J, Fountain Daniel M, Zakaria Rasheed, Pathmanaban Omar N, Mathew Ryan K, Santarius Thomas, Jenkinson Michael D
Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK.
Geoffrey Jefferson Brain Research Centre, Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
Neurooncol Adv. 2023 Jun 3;5(Suppl 1):i26-i34. doi: 10.1093/noajnl/vdac109. eCollection 2023 May.
The widespread availability and use of brain magnetic resonance imaging and computed tomography has led to an increase in the frequency of incidental meningioma diagnoses. Most incidental meningioma are small, demonstrate indolent behavior during follow-up, and do not require intervention. Occasionally, meningioma growth causes neurological deficits or seizures prompting surgical or radiation treatment. They may cause anxiety to the patient and present a management dilemma for the clinician. The questions for both patient and clinician are "will the meningioma grow and cause symptoms such that it will require treatment within my lifetime?" and "will deferment of treatment result in greater treatment-related risks and lower chance of cure?." International consensus guidelines recommend regular imaging and clinical follow-up, but the duration is not specified. Upfront treatment with surgery or stereotactic radiosurgery/radiotherapy may be recommended but this is potentially an overtreatment, and its benefits must be balanced against the risk of related adverse events. Ideally, treatment should be stratified based on patient and tumor characteristics, but this is presently hindered by low-quality supporting evidence. This review discusses risk factors for meningioma growth, proposed management strategies, and ongoing research in the field.
脑磁共振成像和计算机断层扫描的广泛应用导致偶然发现的脑膜瘤诊断频率增加。大多数偶然发现的脑膜瘤体积较小，在随访期间表现为惰性生长，无需干预。偶尔，脑膜瘤生长会导致神经功能缺损或癫痫发作，从而促使进行手术或放射治疗。它们可能会给患者带来焦虑，并给临床医生带来管理难题。患者和临床医生面临的问题都是“脑膜瘤会生长并导致症状，以至于在我有生之年需要治疗吗？”以及“推迟治疗会导致更高的治疗相关风险和更低的治愈机会吗？”国际共识指南建议进行定期影像学和临床随访，但随访时长未作规定。可能会建议早期进行手术或立体定向放射外科/放射治疗，但这可能属于过度治疗，其益处必须与相关不良事件的风险相权衡。理想情况下，应根据患者和肿瘤特征进行分层治疗，但目前这受到低质量支持证据的阻碍。本综述讨论了脑膜瘤生长的危险因素、建议的管理策略以及该领域正在进行的研究。
