File 21: MALIGNANT MENINGIOMA
To the MGH/Harvard
Meningioma Treatment Homepage
To the Introduction and Contents of Management
of Cranial and Spinal Meningiomas
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.
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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
(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.
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.
|TABLE 17.20 Malignant
|Sphenoid wing-cavernous sinus
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
|TABLE 17.21 Malignant
|No evidence of tumor
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