Management of Benign and Aggressive Intracranial Meningiomas

Meningioma is a prime example of a tumor requiring a multimodality approach. This tumor is usually benign and often grows slowly. Under many circumstances, such a benign tumor would never attract the attention of the oncologist or even require treatment at all. However, a meningioma is a benign tumor in a malignant location. In the closed space of the skull, there is no room for expansion of even a benign lesion; thus, effective treatment of this potentially neurologically devastating lesion is necessary. Neurosurgeons, neuroradiologists, radiotherapists, and medical oncologists are all directly involved in treatment decisions. Rapidly expanding knowledge concerning the etiology and natural history of meningiomas may now also involve epidemiologists, molecular geneticists, and endocrinologists. Despite this concentration of expertise, numerous questions remain unanswered or incompletely answered.