Incidental intracranial meningiomas:our experience in the last 8 years

Introduction.The increased use of magnetic resonan-ce and computed tomography imaging has facilitatedthe diagnosis of brain tumours even before the patientsshow clinical symptoms and signs. A significant amountof incidental lesions identified are meningiomas. Thenatural history of incidental intracranial meningiomas mustbe known in order to develop the optimal therapeuticstrategy: what is the tumor growth rate? How many asymp-tomatic tumours eventually become symptomatic?Object. The aim of this study was to report our expe-rience of incidental asymptomatic intracranial menin-giomas and the different adopted treatment modali-ties, such as conservative treatment, microsurgery (MS)and Cyber-Knife radiosurgery.Materials and Methods. We searched retrospectivelyall patients with intracranial meningiomas treated inour Department in the last 8 years. Between January2004 and May 2012, 188 patients with intracranial me-ningiomas were examined. Among those patients, 24cases (12,8%) presented an incidental meningioma. Thisgroup was made up of 17 females (71%) and 7 males(29%), with a mean age of 67 years. The incidentalfinding was consequent to head trauma in 16 cases,endocrinal disorders in 3 cases, acute cerebrovasculardisease in 3 cases, typical trigeminal neuralgia with aneurovascular conflict in 1 case, and senile dementia in1 patient. Treatment modalities were essentially micro-surgical removal of the tumour, Cyber-Knife radiosur-gery and clinical observation.Results and conclusions. In our series, 12 patientsunderwent surgical treatment (6 females and 6 males,mean age of 65 years), 3 patients were treated withCyber-knife radiosurgery (all females, mean age of 66years), while 9 patients (8 females and 1 male, mean ageof 70 years) were clinically monitored. Surgical treatedpatients did not have any permanent neurologic defici-ts and no tumor recurrence occurred. After Cyber-knifetreatment, tumor size remained stable in 1 patient anddecreased in 2 patients.In case of incidental meningioma, the location, size,radiological aspect, age, and the multiplicity of thelesions must be considered. The radiological characte-ristics associated with low tumoral growth rate are theexistence of calcifications and hypointense regions onT2-weighted MR images. On the radiological aspect,more than 60% of asymptomatic meningiomas will notgrow in size. However, some meningiomas, even smallin size, must be treated because of their location or therisk of producing neurological deficits, expecially inyoung patients.