eMedicine Specialties > Neurology > Neuro-oncology

Meningioma: Follow-up

Author: Georges Haddad, MD, Clinical Assistant Professor, Department of Medicine, Division of Neurosurgery, American University of Beirut, Lebanon
Coauthor(s): Ali Turkmani, MD, Staff Physician, Department of Neurosurgery, American University Hospital; Tarafa Baghdadi, MD, Staff Physician, Department of Neurosurgery, American University Hospital; Roukoz B Chamoun, MD, Staff Physician, Department of Neurosurgery, American University of Beirut Medical Center
Contributor Information and Disclosures

Updated: Jun 30, 2009

Follow-up

Further Inpatient Care

  • Before or after surgery, patients with skull-base meningiomas may have numerous disabilities, such as diplopia, dysphasia, dysphagia, or motor weakness.
  • These problems should be managed with a multidisciplinary approach (eg, occupational therapy, physiotherapy, speech therapy).

Further Outpatient Care

  • Patients who undergo operation for meningiomas should receive regular follow-up with enhanced MRI to check for possible recurrences.22
  • Patients who are discharged home with antiepileptic agents should be monitored by a neurologist.

Prognosis

  • Patients whose meningiomas are completely resected usually have an excellent prognosis.
  • The following types of meningiomas are most likely to recur: incompletely excised, malignant, or multiple tumors.

Miscellaneous

Medicolegal Pitfalls

  • Several lesions may mimic meningiomas, including acoustic schwannomas, metastases (single or multiple), osteomas, chondrosarcomas, eosinophilic granulomas, and neurosarcoidosis.
  • Neurosarcoidosis is more prevalent among African Americans than among other races, and it is more common at the base of the skull. If sarcoidosis is suspected, order a chest radiograph and a serum angiotensin-converting enzyme (ACE) level. Neurosarcoidosis may shrink impressively after a trial of corticosteroids.
  • The physician should keep in mind that what appears on radiologic studies like a metastasis in a patient with cancer may actually be a meningioma. An association of meningiomas and breast carcinoma has been reported.

Special Concerns

  • The study of meningiomas is advancing rapidly in the fields of basic science and surgical techniques. This chapter recapitulates briefly the present body of knowledge (with a clinical emphasis).
  • The appended reading list will allow interested readers to further their knowledge and to find several works outlining the details of the presented surgical approaches.
  • For the neurosurgeon, meningiomas are still the ultimate barometer of technical skills (from the small convexity meningioma to the large petroclival meningioma).
 


More on Meningioma

Overview: Meningioma
Differential Diagnoses & Workup: Meningioma
Treatment & Medication: Meningioma
Follow-up: Meningioma
Multimedia: Meningioma
References
Further Reading
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Further Reading

Clinical guidelines
Improving outcomes for people with brain and other CNS tumours.
National Collaborating Centre for Cancer - National Government Agency [Non-U.S.].  2006 Jun. 180 pages.  NGC:005147

Gu ideline for the diagnosis, investigation and management of polycythaemia/erythrocytosis.
British Committee for Standards in Haematology - Professional Association.  2005 Jul.  22 pages. NGC:006179

ACR Appropriateness Criteria® orbits, vision, and visual loss.
American College of Radiology - Medical Specialty Society. 1999 (revised 2006). 9 pages. NGC:005122

Clinical trials

Phase II Trial of Sunitinib (SU011248) in Patients With Recurrent or Inoperable Meningioma

Monthly SOM230C for Recurrent or Progressive Meningioma

Biobank Meningioma: Storing Blood for Analysis of DNA and Protein of Patients With Meningioma


Related eMedicine topics

Meningioma, Brain

Meningioma, Spine

Meningioma, Optic Nerve Sheath

Meningioma, Sphenoid Wing

Skull Base Tumors

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Keywords

meninges, meningeal carcinoma, meningeal cancer, arachnoidal cap cells, primary intracranial neoplasms, asymptomatic meningioma, neurofibromatosis-2, NF-2, familial meningiomas, primary intracranial tumors, hyperostosis, seizures, dysphasia, disinhibited behavior, somnolence, urinary incontinence, anosmia, ipsilateral optic atrophy

contralateral papilledema, Kennedy-Foster syndrome, diplopia, facial numbness, contralateral hemianopsia, facial weakness, Brown-Sequard syndrome, hemispinal cord syndrome, exophthalmos, monocular loss of vision, blindness, ipsilateraldilated pupil, monocular optic nerve swelling, optociliary shunt vessels, multiple cranial nerve palsies, paraparesis, sphincteric troubles, tongue atrophy

transient ischemic attack–like episodes, TIA–like episodes, stroke, intraventricular meningiomas, obstructive hydrocephalus, panhypopituitarism, visual field defects, raised intracranial pressure, brain herniation, decreased mentation, decreased facial sensation, facialparesis, decreasedhearing, deviation of uvula, hemiatrophy of tongue, pronator drift,hyperreflexia, positive Hoffman sign, Babinski sign, parietal-lobe syndrome, Gerstmann syndrome, agraphia, acalculia, right-left disorientation, finger agnosia, tactile extinction, neglect of contralateral side

visual extinction, congruent homonymous hemianopsia, spinal meningiomas, decreased pain sensation, quadriparesis, sphincteric weakness, ipsilateral weakness, decrease in position sense, cranial irradiation, chromosome 22q, merlin, schwannomin, anaplastic meningioma, monosomy of chromosome 7, loss of progesterone receptors, increased expression of ornithinedecarboxylase, increased expression of cyclooxygenase 2, radiation-induced meningiomas, matrix metalloproteinases, MMPs, tissue inhibitors of MMPs, TIMPs

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Contributor Information and Disclosures

Author

Georges Haddad, MD, Clinical Assistant Professor, Department of Medicine, Division of Neurosurgery, American University of Beirut, Lebanon
Georges Haddad, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Ali Turkmani, MD, Staff Physician, Department of Neurosurgery, American University Hospital
Disclosure: Nothing to disclose.

Tarafa Baghdadi, MD, Staff Physician, Department of Neurosurgery, American University Hospital
Disclosure: Nothing to disclose.

Roukoz B Chamoun, MD, Staff Physician, Department of Neurosurgery, American University of Beirut Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Frederick M Vincent Sr, MD, Clinical Professor, Department of Neurology and Ophthalmology, Michigan State University Colleges of Human and Osteopathic Medicine
Frederick M Vincent Sr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Forensic Examiners, American College of Legal Medicine, American College of Physicians, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jorge Kattah, MD, Head, Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria
Jorge Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and New York Academy of Sciences
Disclosure: Biogen Honoraria Consulting; Bayer Corporation Honoraria Consulting

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Tarakad S Ramachandran, MBBS, FRCP(C), FACP, Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital
Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine
Disclosure: Abbott Labs  Honoraria Consulting; Teva Marion Honoraria Consulting; Boeringer-Ingelheim Honoraria Speaking and teaching

 
 
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