Diagnosis and treatment of atypical and anaplastic meningiomas: a review

Neurosurgery. 2005 Sep;57(3):538-50; discussion 538-50. doi: 10.1227/01.neu.0000170980.47582.a5.

Abstract

Atypical and anaplastic meningiomas are uncommon tumors with a poorer prognosis than benign meningiomas. We reviewed the current literature and attempted to integrate and summarize available information to determine a logical approach to these tumors. Both tumors are rare and are often integrated with benign meningiomas when treatments are evaluated. In addition, because there has not been one histopathological classification scheme for atypical and anaplastic meningiomas in the past, there are numerous inconsistencies in the literature. Malignant progression with accumulation of mutations in a benign meningioma can result in an atypical and/or anaplastic meningioma. Both tumors are difficult to manage and have high recurrence and poor survival rates. The extent of tumor resection and histological grade are the key determinants for recurrence. In addition, metastases are unusual, but they do occur. We also review the evidence available that has resulted in the current World Health Organization classification. Radiation therapy can be used as an adjunctive treatment after both total and subtotal resection. In addition, the role of stereotactic radiosurgery is increasing, along with a possible role for brachytherapy. There are no effective chemotherapeutic agents available. A treatment algorithm is suggested.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Anaplasia / diagnosis
  • Anaplasia / metabolism
  • Anaplasia / therapy
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / metabolism
  • Brain Neoplasms / therapy*
  • Disease Progression
  • Drug Therapy / methods
  • Humans
  • Immunohistochemistry / methods
  • Magnetic Resonance Imaging
  • Meningeal Neoplasms / diagnosis
  • Meningeal Neoplasms / metabolism
  • Meningeal Neoplasms / therapy*
  • Meningioma / diagnosis
  • Meningioma / metabolism
  • Meningioma / therapy*
  • Radiosurgery
  • Vascular Endothelial Growth Factor Receptor-2 / metabolism

Substances

  • Vascular Endothelial Growth Factor Receptor-2