ORIGINAL ARTICLE - BRAIN TUMORS
Non-operative meningiomas: long-term follow-up of 136 patients
Received: 6 November 2017 /Accepted: 18 April 2018
Springer-Verlag GmbH Austria, part of Springer Nature 2018
Background Improving access to neuroradiology investigations has led to an increased rate of diagnosis of incidental
Method A cohort of 136 incidental meningioma patients collected by a single neurosurgeon in a single neurosurgical centre is
retrospectively analysed between 2002 and 2016. Demographic data, imaging and clinical features are presented. The radiolog-
ical factors associated with meningiomas progression are also presented.
Results The mean age at diagnosis was 65 (range, 33–94) years. Univariate analysis showed oedema was most strongly correlated
with progression (p = 0.010) followed by hyperintensity in T2-weighted (T2W) MRI (p = 0.029) and in Flair-T2W MRI (p =0.017).
Isointensity in Flair-T2W MRI (0.004) was most strongly correlated with non-progression of the meningioma followed by calci-
fication (p = 0.007), older age (p = 0.087), hypointensity in Flair-T2W MRI (p = 0.014) sequences and in T2W MRI (p = 0.096). In
multivariate analysis, the strongest radiological factor predictive of progression was peritumoural oedema (p = 0.016) and that of
non-progression was calcification (p = 0.002). At the end of the median follow-up (FU) of 43 (range, 4–150) months, 109 (80%)
patients remained clinically stable, 13 (10%) became symptomatic and 14 (10%) showed clinical and radiological progression.
Conclusions One hundred and nine (80%) patients remained stable at the end of FU. Peritumoural oedema was predictive of
meningiomas progression. Further prospective study is needed to identify the combination of factors which can predict the
meningioma progression for an early surgery or early discharge.
Magnetic resonance imaging
Meningiomas account for around 20% of all intracranial tu-
mours in males and 38% in females . These tumours orig-
inate from meningothelial cells, called arachnoid cap cells, of
the arachnoid granulations mainly concentrated at the venous
sinuses and major venous structures [4, 11].
The female preponderance of these tumours is correlated
with sex hormone influences previously described in the liter-
ature [1, 5, 13]. The majority of meningiomas are benign as
follows: benign WHO grade I (> 90%); atypical/borderline,
grade II (5%); anaplastic/malignant, grade III (2–3%) .
Improving access to neuroradiology investigations has led
to an increased rate of diagnosis of incidental meningiomas
especially in the past two decades. Incidental meningiomas
are the most frequent incidental findings following diagnostic
brain imaging . In the pre-CT/MRI imaging era, these tu-
mours were diagnosed when they were large and symptomat-
ic. They are frequently followed up by neurologists, general
practitioners and neurosurgeons. The surgical removal of
symptomatic or growing tumours compressing surrounding
brain or neurovascular structures is generally recognised as
However, the management of an incidentally discovered
meningioma is controversial and options include the follow-
ing: watch, wait and rescan (WWR), microsurgical removal
(MR), radiosurgery (RS) or fractionated radiotherapy (RT).
National or international guidelines regarding the modality
of follow-up (FU) of asymptomatic incidental meningiomas
are lacking. Furthermore, there is an absence of prospective
studies of large cohorts of WWR patients in order to detect
* Rossana Romani
Department of Neurosurgery, Charing Cross Hospital, Imperial
College NHS Trust, Fulham Palace Rd, London W6 8RF, UK
Department of Neurosurgery, Essex Neuroscience Centre, Queen’s
Hospital, Romford RM7 0AG, UK
Department of Mathematics and Statistics, University of Helsinki,
2b, P.O. Box 68, FI-00014 Helsinki, Finland