MGHbanner BulfinchBldg
Cranial Base Ceneter at MGH
Cranial Base Center at MGH
Otolaryngology at MEEINeurosurgery at MGHRadiation Oncology at MGH
MEEI

Massachusetts General HospitalHarvard Medical School

MGH  Neurosurgical Service HomeMGH ShieldHvd Med Sch ShieldPartners Logo
A joint program of the Departments of Otolaryngology, Neurosurgery, and Radiation Oncology dedicated to the evaluation and treatment of patients with cranial base lesions. Including the Cranial Base Center News - A newsletter with information regarding lesions affecting the base of the skull including acoustic neuromas (vestibular schwannoma) and other tumors of the cranial nerves).
Neurosurgery @ MGHPeople @ MGH NeurosurgeryClinical Centers @ MGH NeurosurgeryResearch @ MGH NSEducation @ MGH NeurosurgerySupport Groups @ MGH NeurosurgeryNews @ MGH NeurosurgeryReferrals @ MGH Neurosurgery
Management of Meningiomas
File 21: MALIGNANT MENINGIOMA

To the MGH/Harvard Meningioma Treatment Homepage
To the Introduction and Contents of Management of Cranial and Spinal Meningiomas

by ROBERT G. OJEMANN, M.D.
Congress of Neurological Surgeons Honored Guest Presentation
Originally Published Clinical Neurosurgery, Volume 40, Chapter 17, Pages 321-383, 1992
Used with permission of the Congress of Neurological Surgeons.

HTML Editor: Stephen B. Tatter, M.D., Ph.D.

CBC Members | Referrals | Newsletter | Guestbook | Links | Selected Publications | CBC HomePage


Disclaimer: The information and reference materials contained herein are intended solely to provide background information. They were written for an audience of physicians. They are in no way intended to constitute medical advise. For medical advise a physician must, of course, be consulted.

Contents


MALIGNANT MENINGIOMAS

(Meningioma Management, File 21)

In most patients a preoperative diagnosis of malignant meningioma is not made. Therefore, the initial management decisions are the same as outlined for each location of tumor. The most important surgical consideration is to make as wide an excision as possible of the dura and/or falx around the tumor. Some patients have required multiple operations.
TABLE 17.20 Malignant Meningioma Locations
Location Number
Sphenoid wing-cavernous sinus 1
Parasagittal 10
Convexity 3
Tentorial 1
Cerebellopontine angle 3
Spine 1
Radiation therapy is used at some point in the management of most of these patients. When to give the therapy has not been defined. When I thought there was a gross total removal I usually postponed radiation therapy and carefully observed the patient. When there was recurrence and the findings on the scan suggested that another total removal could be done, surgery was performed.

In this series there were 19 patients (5.1% of the series) who were classified as having a malignant meningioma. Patients with hemangiopelicytoma are not included. There were 10 women and nine men, ranging in age from 17 to 77 years, with five over 70 years of age. The histological criteria used to define malignant meningiomas have been described by the World Health Organization (57). Six criteria are considered: hypercellularity, loss of architecture ("sheeting"), nuclear pleomorphism, mitotic index, focal necrosis, and brain invasion. I have considered these tumors separately because of the difference in clinical behavior, compared with benign and atypical meningiomas. The locations of the malignant meningiomas are recorded in Table 17.20 and the results of treatment in Table 17.21. Eleven patients are alive 1-10 years after treatment. Seven have no evidence of tumor (three received radiation therapy), three have a stable residual tumor (two received radiation therapy), and one has a progressive growth of tumor in spite of surgery and radiation therapy.

TABLE 17.21 Malignant Meningioma Outcomes
Results Number Radiation
Therapy
Alive
No evidence of tumor 7 3
Stable tumor 3 2
Tumor growing 1 1
Dead
From tumor 7 5
Other cause 1 0


To the MGH/MEEI/Harvard Cranial Base Center or the MGH Proton Beam Radiosurgery Homepage.
Ceanial Base Center at MGH Members | Referrals | Newsletter | Guestbook
Links | Selected Publications | CBC HomePage
[Divider]

Disclaimer About Medical Information: The information and reference materials contained herein is intended solely for the information of the reader. It should not be used for treatment purposes, but rather for discussion with the patient's own physician. All visitors to this and associated sites from the Neurosurgical Service at MGH agree to read and abide by the the complete terms of legal agreement found at the Neurosurgery "disclaimer & legal agreement." See also: the MGH Disclaimer, the MGH Privacy Policy, and the MGH Interactive Program Disclaimer - Copyright 2005.
[Divider]
electronswebs
MGH  Neurosurgical Service Home
Research@NeurosurgeryVisitors must read the disclaimer - legal agreement.
All Rights Reserved. Copyright 20005 MGH Neurosurgical Service
Neurosurgery@MGH
IntraNet

(internal access only)
System Info Contact: WebServant or the PageServant or e-mail C.Owen
Last modified: May 11, 2005
Referral@Neurosurgery.MassGeneral.org