Introduction
Background
Meningiomas represent 15% of all brain tumors. They are the most common extra-axial tumors in the brain and the most frequently occurring tumors of mesodermal or meningeal origin.
Advances in radiologic imaging techniques, such as CT and MRI, have improved the surgeon's ability to predict the success for complete removal of the mass. Imaging information about the dural attachment site, location and severity of edema, and displacement of critical neurovascular structures is useful for planning the operative approach and does affect outcome.
Neuroradiologists and neurosurgeons must be aware of both the typical and atypical imaging appearances of meningiomas, as there is some correlation with different histologic types of tumor.
For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. Also, see eMedicine's patient education article Brain Cancer.
Pathophysiology
Meningiomas are believed to arise from the same cells that give rise to the arachnoid villi and arachnoid endothelium. Surface meningiomas originate from the arachnoid cells imbedded in the dura, while intraventricular tumors arise from pia-arachnoid rests. Meningiomas occur more frequently where the villi usually are most numerous, ie, along the major dural venous sinus. The tumors typically have a definite dural attachment.
Frequency
United States
In males, the prevalence of meningiomas is 1.2 cases per 100,000 population. In females, the prevalence is 2.6 cases per 100,000 population. The ratio of meningiomas to gliomas in a Mayo Clinic group was 1:2. Relative frequency of intracranial tumors in large series by Zimmerman attributed 12.5% of tumors to meningiomas.1
International
Meningiomas constituted 30% of brain tumors in Bantus, Africa. European reports show meningiomas account for approximately 15% of brain tumors.
It has been reported that the incidence of meningioma increased in several industrialized countries in the late 1970s and early 1980s. In Denmark, Finland, Norway and Sweden the combined incidence among men increased from 1.4 to 1.9 per 100,000 during the follow-up period, the corresponding rates for women were 2.6 and 4.5. The decrease in the rate or detection postmortem has affected the incidence time trend, but it also coincides with widespread use of new imaging technologiesThe high incidence of meningiomas in Iran (29%) is thought to be partly due to the late effect of mild doses of radiation of the scalp that some of these patients received in early childhood for treatment of ring worm of the scalp.
No overall increased risk of glioma or meningioma has been observed among cellular phone users; however, for long-term cellular phone users, results need to be confirmed before firm conclusions can be drawn.
Mortality/Morbidity
Survival rates from surgical series are 82%, 72%, and 60% at 2, 5, and 10 years, respectively.
- At 5 years, no difference is noted in survival rates for males versus females or for race or ethnicity.
- Among patients older than 70 years who underwent surgery for meningioma, the neurologic complications rate reached approximately 23% and was approximately 3% in younger patients.
- In general, postoperative results are better in patients with few concomitant diseases, smaller meningiomas, less edema, shorter surgery times, and a more accessible location (ie, convexity rather than skull base).
Race
During 1975-1985, ethnic analysis from the Armed Forces Institute of Pathology, Washington, DC, showed a slightly higher frequency of meningiomas in blacks, with a white-to-black case ratio of 6.7:1, as compared with the US white-to-black population ratio of 7.4:1. More meningiomas are found in African Americans than in other Americans.
- The following findings strongly suggest that meningioma is one of the tumors induced by atomic bombing in Hiroshima. Sixty-eight patients surgically treated for meningioma who had been within 2.0 km of the hypocenter of the explosion were identified. Six hundred and seven non-exposed patients with meningioma were also studied. Treatment dates were from 1975 to 1992. The incidences of meningioma among the survivors of Hiroshima in 5-year intervals since 1975 were 5.3, 7.4, 10.1, and 14.9, respectively. The incidences of meningioma classified by distances from the hypocenter of 1.5-2.0 km, 1.0-1.5 km and less than 1.0 km were 6.3, 7.6 and 20.0, respectively.
Sex
Meningiomas are more common in women than in men, with a male-to-female ratio of 1:2. A reverse male-to-female preponderance of 3:1 has been reported in the malignant form. In a statistical survey of sphenoid ridge meningiomas, 97% were found in female patients.
- An increased relative risk of meningioma has been found among postmenopausal women for ever use of hormone replacement therapy, with an odds ratio of 1.7 (95% confidence interval: 1.0, 2.8). Women who had used long-acting hormonal contraceptives (subdermal implants, injections, or hormonal intrauterine devices) had an increased risk of meningioma; the odds ratio for at least 10 years of use was 2.768% of hospital consultant episodes for benign neoplasm of meninges were for women in England 2002. (Hospital Episode Statistics, Department of Health, England, 2002-03)
Age
Meningiomas have a predilection to occur from the third to sixth decades of life, with a peak incidence occurring in individuals aged approximately 45 years.
- Meningiomas are rare in patients younger than 20 years, and if present, commonly are associated with neurofibromatosis type 2. Of all intracranial meningiomas, 1-2% occur in children and adolescents.
- Intraventricular meningiomas represent 2% of intracranial meningiomas in the adult population but 15-20% of intracranial meningiomas in the pediatric population.
- Tumor genesis of meningioma has been associated with chromosome 22, most notably the NF2 gene, but additional genes have been implicated in meningioma development. It has been reported the identification of five novel immunogenic antigens expressed in meningiomas.Only seven cases of meningioma associated with Gorlin's syndrome have been described. This syndrome, also known as multiple basal cell carcinoma syndrome, is a familial tumor condition with autosomal-dominant inheritance. 40 cases have been described. Patients develop multiple basal cell carcinomas beginning in childhood.61 was the mean age of patients hospitalized for benign neoplasm of meninges in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
Anatomy
Meningiomas arise from arachnoid cells, particularly those packing the arachnoid villi, which protrude as fingerlike projections into the walls of the dural veins and sinuses. Most meningiomas grow inward toward the brain as discrete well-defined, dural-based masses. Most of them are spherical or lobulated. Flat tumors termed en plaque infiltrate the dura and grow as a thin carpet or sheet of tumor along the convexity dura, falx, or tentorium. Dural attachment of meningiomas can be pedunculated or broad-based (sessile). Since the pia and arachnoid form a membranous barrier between brain and tumor, some meningiomas grow into the subarachnoid space, but invasion of the brain is infrequent.
Grossly, meningiomas usually show a lamellar internal structure with a firm central core at the dural attachment and a surrounding, softer, vascular mass at the periphery. The tumor may have a fibrous, soft, or psammomatous-calcified texture and be grossly irregular, reddish, and vascularized. About 90% of meningiomas are located in the supratentorial compartment. Frequent locations are along the falx and laterally over the cerebral convexity. The sphenoidal ridge, juxtasellar area, olfactory groove, posterior fossa, and tentorium are other important sites of attachment. Almost all intraventricular tumors are located in the third or fourth ventricles and the trigone of the lateral ventricle, arising from the velum interpositum or tela choroidea. Occasionally, they arise inside of the frontal horn, near the foramen of Monro, with a slight left-sided predilection (see Table).
Rare examples of meningiomas within the cerebral hemispheres, with no dural attachment, are derived from stromal cells in the spaces surrounding the perforating blood vessels. These are extremely rare.
Microscopically, appearance is variable. The histologic variants include meningotheliomatous, fibroblastic, transitional, psammomatous, angioblastic, and malignant tissue. The World Health Organization (WHO) classifies meningiomas into 3 categories: (1) typical or benign (88-94%), (2) atypical (5-7%), and (3) anaplastic or malignant (1-2%).
Presentation
Except when they compress critical areas, meningiomas can remain clinically asymptomatic for years because of their slow growth. Meningiomas can reach a large size, especially in the frontal lobes, with few symptoms. The primary complaints of patients include focal deficit, seizures, psycho-organic syndrome, and headaches. Usually, the mean duration of symptoms is approximately 15 months, with 30% of histories lasting less than 3 months. Obstruction of CSF pathways is not common because of the convex attachment of tumors, with the exception of intraventricular and posterior fossa locations. Symptoms resulting from tumor hemorrhage are infrequent.Origins of surgically verified meningiomas
Open table in new window
Table
| Site | Cushing and Eisenhardt, 1938 (%) | Naidich et al, 1996 (%) | Traub, 1961 (%) |
|---|---|---|---|
| Parasagittal | 22.0 | 12.5 | 46.5 |
| Free convexity | 18.3 | 17.6 | 32.5 |
| Sphenoidal ridge | 18 | 12.5 | 18.1 |
| Olfactory groove | 9.8 | 5.1 | 7.6 |
| Suprasellar | 9.5 | 9.6 | 2.3 |
| Posterior fossa | 7.8 | 16.2 | 7.6 |
| Peritorcular | 4.7 | 0.7 | |
| Temporal fossa | 2.7 | 3.7 | 5.8 |
| Falx | 2.4 | 13.2 | |
| Choroidal | 2.0 | 3.7 | 2.3 |
| Gasserian | 1.7 | 1.5 | |
| Multiple | 0.7 | 1.5 | |
| Intraorbital | 0.3 | ||
| Combined with neuromas | 0.7 | 1.5 |
| Site | Cushing and Eisenhardt, 1938 (%) | Naidich et al, 1996 (%) | Traub, 1961 (%) |
|---|---|---|---|
| Parasagittal | 22.0 | 12.5 | 46.5 |
| Free convexity | 18.3 | 17.6 | 32.5 |
| Sphenoidal ridge | 18 | 12.5 | 18.1 |
| Olfactory groove | 9.8 | 5.1 | 7.6 |
| Suprasellar | 9.5 | 9.6 | 2.3 |
| Posterior fossa | 7.8 | 16.2 | 7.6 |
| Peritorcular | 4.7 | 0.7 | |
| Temporal fossa | 2.7 | 3.7 | 5.8 |
| Falx | 2.4 | 13.2 | |
| Choroidal | 2.0 | 3.7 | 2.3 |
| Gasserian | 1.7 | 1.5 | |
| Multiple | 0.7 | 1.5 | |
| Intraorbital | 0.3 | ||
| Combined with neuromas | 0.7 | 1.5 |
The clinical behavior of the syncytial, transitional, and fibroblastic histologic types is identical. Angioblastic tumors are more aggressive and have a greater tendency to recur. Anaplastic (sarcomatous) tumors may metastasize to lung, abdominal viscera, and bones. Although the vast majority of meningiomas are benign, a rare malignant form exists; this is termed malignant meningiomatosis or sarcomatosis.
Metastases from malignant meningioma involve the vertebral bodies, liver, pelvis, long bones and the spinal cord. It has been reported to be less than 1 per 1,000. This confers an incidence of metastasis of 0.76% when considering all the meningiomas, and an incidence of approximately 43% when considering only malignant meningioma.
Significant factors contributing to recurrence include the following:
- Incomplete surgical resection (Simpson classification)
- Atypical and malignant histologic types (WHO classification)
- Presence of nucleolar prominence
- Presence of more than 2 mitoses per 10 high-power fields
- Heterogenous tumor contrast enhancement on CT scan
Patients without any of these features showed low recurrence rates of 4% and 18% at 5 and 10 years, respectively.
In the past, microsurgery was the goal of total tumor removal. A more complete removal is associated with a lower risk of recurrence or progression. The surgical removal usually includes bone and/or into which the tumor has spread.
With the increasing availability of radiosurgery throughout the U.S. and the world, surgeons have had to rethink radical surgical removal for tumors that recur or are unresectable. Gamma Knife (GK) it is mainly used for small (<3 cm in diameter) residual, recurrent or tentorial meningiomas. The relatively low minimum tumor radiation dose for skull base menigiomas provide low morbidity. Radiosurgery now is able for providing palliative treatment with favorable long term tumor outcomes and low morbidity.
Complete resection is the optimal treatment for atypical meningiomas, taking into account the tumor site and feasibility. For small- and medium-sized Atypical Meningiomas GK may be a safe adjunct to other treatment modalities.
Radiosurgery proved to be effective in improving meningioma-related trigeminal pain. GK for intracranial meningiomas seems to be a safe and effective treatment. However, meningiomas of the convexity, parasagittal region, or falx cerebri have a higher incidence of peritumorous imaging changes after GK than those of the skull base.
The anti-progestational drug Mifepristone (RU 486), Lovastatin as a potent inhibitor of meningioma cell proliferation, and hydroxyurea chemotherapy has been suggested in recent reports that can cause regression of unresectable and recurrent meningiomas.Surgical remove of the tumor, radiation therapy, radiosurgery and/or growth-modifying drugs may contribute to the best outcome of the meningiomas.
Preferred Examination
MRI is preferred for diagnosis and evaluation. CT well depicts bony hyperostosis, which may be difficult to appreciate on MRI. CT may, however, fail to demonstrate en plaque and posterior fossa meningiomas.
Limitations of Techniques
CT has limitations in performing direct imaging in any other plane than axial. However, with the onset of spiral CT scanning, and, more recently, multisection or multidetector-row CT scanning, the quality of sagittal and coronal images that can be reconstructed from axial data has increased significantly. CT scanning is less helpful than MRI in differentiating different types of soft tissue.
Patients with pacemakers currently cannot be evaluated by means of MRI. Other contraindications to MRI include some brain aneurysm clips and heart valves. The reader is referred to more detailed texts for a complete list of contraindications to MRI. The presence of calcifications and adjacent bony changes are best evaluated by using CT, as MRI is poor in this regard.
Differential Diagnoses
Astrocytoma, Brain
Brain, Cavernous Angiomas
Neurofibromatosis Type 2
Sarcoid, CNS
Tuberculosis, CNS
Other Problems to Be Considered
Dural vascular malformation
Hemangioma
Extramedullary hematopoiesis
More on Meningioma, Brain |
 Overview: Meningioma, Brain |
| Imaging: Meningioma, Brain |
| Follow-up: Meningioma, Brain |
| Multimedia: Meningioma, Brain |
| References |
| Next Page » |
References
Zimmerman HM. Brain tumors: their incidence and classification in man and their experimental production. Ann New York Acad Sci. 1969;159:337-59.
Albrecht S, Goodman JC, Rajagopolan S. Malignant meningioma in Gorlin's syndrome: cytogenetic and p53 gene analysis. Case report. J Neurosurg. Sep 1994;81(3):466-71.
Ameli N, Haddadian A, Kamalian N. Incidence of intracranial tumours in Iran. A survey of 1500 verified cases. Neurosurg Rev. June 1979;2(2):67-71.
Annegers JF, Schoenberg BS, Okazaki H, et al. Epidemiologic study of primary intracranial neoplasms. Arch Neurol. Apr 1981;38(4):217-9. [Medline].
Ayerbe J, Lobato RD, de la Cruz J, et al. Risk factors predicting recurrence in patients operated on for intracranial meningioma. A multivariate analysis. Acta Neurochir (Wien). 1999;141(9):921-32. [Medline].
Berlin L. Malpractice and radiologists, update 1986: an 11.5-year perspective. AJR Am J Roentgenol. Dec 1986;147(6):1291-8. [Medline].
Bigner DD, McLendon RE, Bruner JM, eds. Russell and Rubenstein's Pathology of Tumours of the Nervous System. 6th ed. New York: Oxford University Press; 1998.
Boldrey E. Meningiomas. In: Minckler J, ed. Pathology of the Nervous System. 2nd ed. New York:. McGraw-Hill;1971: 2125-44.
Breger RK, Papke RA, Pojunas KW, et al. Benign extraaxial tumors: contrast enhancement with Gd-DTPA. Radiology. May 1987;163(2):427-9. [Medline].
Buetow MP, Buetow PC, Smirniotopoulos JG. Typical, atypical, and misleading features in meningioma. Radiographics. Nov 1991;11(6):1087-106. [Medline].
Buhl R, Hasan A, Behnke A, et al. Results in the operative treatment of elderly patients with intracranial meningioma. Neurosurg Rev. Mar 2000;23(1):25-9. [Medline].
Chang JH, Chang JW, Choi JY. Complications after gamma knife radiosurgery for benign meningiomas. J Neurol Neurosurg Psychiatry. Feb 2003;74(2):226-30.
Changhong L, Naiyin C, Yuehuan G. Primary intraosseous meningiomas of the skull. Clin Radiol. Jul 1997;52(7):546-9. [Medline].
Comtesse N, Heckel D, Racz A. Five novel immunogenic antigens in meningioma: cloning, expression analysis, and chromosomal mapping. Clin Cancer Res. Nov 1999;5(11):3560-8.
Cushing H, Eisenhardt L. Meningiomas: Their Classification, Regional Behavior, Life History and Surgical End Results. Springfield, IL: Charles C Thomas Publishers;1938.
D'Ambrosio AL, Bruce JN. Treatment of meningioma: an update. Curr Neurol Neurosci Rep. May 2003;3(3):206-14.
Daffner RH, Yakuis R, Maroon JC. Intraosseous meningioma. Skeletal Radiol. Feb 1998;27(2):108.
Dawson RC, Horton JA, Bertuccini TV. Interventional neuroradiology in the community hospital. J La State Med Soc. Jan 1989;141(1):27-32. [Medline].
De la Sayette V, Rivaton F, Chapon F, et al. Meningioma of the third ventricle. Computed tomography and magnetic resonance imaging. Neuroradiology. 33(4):354-6. [Medline].
Demaerel P, Wilms G, Lammens M, et al. Intracranial meningiomas: correlation between MR imaging and histology in fifty patients. J Comput Assist Tomogr. Jan-Feb 1991;15(1):45-51. [Medline].
Elster AD, Challa VR, Gilbert TH, et al. Meningiomas: MR and histopathologic features. Radiology. Mar 1989;170(3 Pt 1):857-62. [Medline].
Enam SA, Abdulrauf S, Mehta B. Metastasis in meningioma. Acta Neurochir (Wien). 1996;138(10):1172-7; discussion 1177-8.
Fan KJ, Pezeshkpour GH. Ethnic distribution of primary central nervous system tumors in Washington, DC, 1971 to 1985. J Natl Med Assoc. Oct 1992;84(10):858-63. [Medline].
Feun LG, Raub WA Jr, Landy HJ, et al. Retrospective epidemiologic analysis of patients diagnosed with intracranial meningioma from 1977 to 1990 at the Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center: the Jackson Memorial Hospital Tumor Registry experience. Cancer Detect Prev. 1996;20(2):166-70. [Medline].
Forbes G, Earnest F 4th, Jackson IT, et al. Therapeutic embolization angiography for extra-axial lesions in the head. Mayo Clin Proc. Jun 1986;61(6):427-41. [Medline].
Gentry LR, Jacoby CG, Turski PA, et al. Cerebellopontine angle-petromastoid mass lesions: comparative study of diagnosis with MR imaging and CT. Radiology. Feb 1987;162(2):513-20. [Medline].
Haddad G, Chamoun RB. Meningioma. eMedicine Journal [serial online]. 2006;[Full Text].
Hamada J, Kai Y, Nagahiro S. Embolization with cellulose porous beads, II: clinical trial. AJNR Am J Neuroradiol. Nov-Dec 1996;17(10):1901-6. [Medline].
Hamer MM, Morlock F, Foley HT, et al. Medical malpractice in diagnostic radiology: claims, compensation, and patient injury. Radiology. Jul 1987;164(1):263-6. [Medline].
Hodgson TJ, Kingsley DP, Moseley IF. The role of imaging in the follow up of meningiomas. J Neurol Neurosurg Psychiatry. Nov 1995;59(5):545-7. [Medline].
Huffmann BC, Reinacher PC, Gilsbach JM. Gamma knife surgery for atypical meningiomas. J Neurosurg. Jan 2005;102 Suppl:283-6.
Huk K. A study of the incidence of calcification in a histological survey of surgical biopsies of meningiomas. J Neurosurg. 1964;21:751-7.
Iwai Y, Yamanaka K, Yasui T, et al. Gamma knife surgery for skull base meningiomas. The effectiveness of low-dose treatment. Surg Neurol. Jul 1999;52(1):40-4; discussion 44-5. [Medline].
Johnson MD, Woodard A, Okediji EJ, et al. Lovastatin is a potent inhibitor of meningioma cell proliferation: evidence for inhibition of a mitogen associated protein kinase. J Neurooncol. Jan 2002;56(2):133-42.
Kienecker EW. Diagnostical and clinical appearance of the sphenoidal ridge meningioma en plaque. Adv Neurosurg. 1986;2:68-70.
Kizana E, Lee R, Young N, et al. A review of the radiological features of intracranial meningiomas. Australas Radiol. Nov 1996;40(4):454-62. [Medline].
Klaeboe L, Lonn S, Scheie D, et al. Incidence of intracranial meningiomas in Denmark, Finland, Norway and Sweden, 1968-1997. Int J Cancer. Dec 20 2005;117(6):996-1001.
Kuratsu J, Kochi M, Ushio Y. Incidence and clinical features of asymptomatic meningiomas. J Neurosurg. May 2000;92(5):766-70. [Medline].
Lamberts SW, Tanghe HL, Avezaat CJ, et al. Mifepristone (RU 486) treatment of meningiomas. J Neurol Neurosurg Psychiatry. Jun 1992;55(6):486-90.
Laughlin S, Montanera W. Central nervous system imaging. When is CT more appropriate than MRI?. Postgrad Med. Nov 1998;104(5):73-6, 81-4, 87-8.
Maiuri F, Iaconetta G, de Divitiis O, et al. Intracranial meningiomas: correlations between MR imaging and histology. Eur J Radiol. Jul 1999;31(1):69-75. [Medline].
Mason WP, Gentili F, Macdonald DR, et al. Stabilization of disease progression by hydroxyurea in patients with recurrent or unresectable meningioma. J Neurosurg. Aug 2002;97(2):341-6.
Michalik M, Lehmann R, Synowitz HJ, Unger RR. [Diagnostic classification of intracranial meningiomas in the serial angiogram]. Zentralbl Neurochir. 1978;39(1):45-56. [Medline].
Morrison MC, Weiss KL, Moskos MM. CT and MR appearance of a primary intraosseous meningioma. J Comput Assist Tomogr. Jan-Feb 1988;12(1):169-70. [Medline].
Muthukumar N, Kondziolka D, Lunsford LD, et al. Stereotactic radiosurgery for tentorial meningiomas. Acta Neurochir (Wien). 1998;140(4):315-20; discussion 320-1.
Naidich TP. Meningiomas. Core Curriculum Course in Neuroradiology. Part II: Neoplasms and Infectious Diseases. Oak Brook, IL: American Society of Neuroradiology;1996: 53-60.
Naidich TP, Riftkin MD, Leeds NE, et al. Evaluation of meningiomas by computed axial tomography. Paper presented at: Annual Meeting of the American Society of Neuroradiology;. 1977; Hamilton, Bermuda.
Nelson PK, Setton A, Choi IS, et al. Current status of interventional neuroradiology in the management of meningiomas. Neurosurg Clin N Am. Apr 1994;5(2):235-59. [Medline].
New PF, Hesselink JR, O'Carroll CP, et al. Malignant meningiomas: CT and histologic criteria, including a new CT sign. AJNR Am J Neuroradiol. May-Jun 1982;3(3):267-76. [Medline].
Osborn AG. Diagnostic Neuroradiology. St Louis: Mosby-Year Book;1994: 584-603.
Peh WC, Fan YW. Case report: intraventricular meningioma with cerebellopontine angle and drop metastases. Br J Radiol. Apr 1995;68(808):428-30. [Medline].
Perry RD, Parker GD, Hallinan JM. CT and MR imaging of fourth ventricular meningiomas. J Comput Assist Tomogr. Mar-Apr 1990;14(2):276-80. [Medline].
Pollock BE, Iuliano BA, Foote RL, et al. Stereotactic radiosurgery for tumor-related trigeminal pain. Neurosurgery. Mar 2000;46(3):576-82; discussion 582-3.
Pompili A, Cacciani L, Cattani F, et al. [Intracranial meningiomas in the elderly]. Minerva Med. Jun 1997;88(6):229-36. [Medline].
Probst EN, Grzyska U, Westphal M, et al. Preoperative embolization of intracranial meningiomas with a fibrin glue preparation. AJNR Am J Neuroradiol. Oct 1999;20(9):1695-702. [Medline].
Ramsey RH. Meningiomas. In: Neuroradiology with Computed Tomography. Philadelphia: WB Saunders Co;1981:405-44.
Rubinstein LJ. Tumors of the Central Nervous System. 2nd ed. Washington, DC:. Armed Forces Institute of Pathology;1972:169-86.
Russell EJ, Berenstein A. Neurologic applications of interventional radiology. Neurol Clin. Nov 1984;2(4):873-902. [Medline].
Russell EJ, George AE, Kricheff II, et al. Atypical computed tomography features of intracranial meningioma: radiological-pathological correlation in a series of 131 consecutive cases. Radiology. Jun 1980;135(3):673-82. [Medline].
Schubeus P, Schorner W, Rottacker C, et al. Intracranial meningiomas: how frequent are indicative findings in CT and MRI?. Neuroradiology. 1990;32(6):467-73. [Medline].
Shintani T, Hayakawa N, Hoshi M, et al. High incidence of meningioma among Hiroshima atomic bomb survivors. J Radiat Res (Tokyo). Mar 1999;40(1):49-57.
Spagnoli MV, Goldberg HI, Grossman RI, et al. Intracranial meningiomas: high-field MR imaging. Radiology. Nov 1986;161(2):369-75. [Medline].
Spring DB, Tennenhouse DJ. Radiology malpractice lawsuits: California jury verdicts. Radiology. Jun 1986;159(3):811-4. [Medline].
Steinhoff H, Lanksch W, Kazner E, et al. Computed tomography in the diagnosis and differential diagnosis of glioblastomas. A qualitative study of 295 cases. Neuroradiology. Dec 31 1977;14(4):193-200. [Medline].
Suzuki Y, Sugimoto T, Shibuya M, et al. Meningiomas: correlation between MRI characteristics and operative findings including consistency. Acta Neurochir (Wien). 1994;129(1-2):39-46. [Medline].
Takahashi M. [Magnetic resonance imaging of brain tumors]. Gan To Kagaku Ryoho. Dec 1987;14(12):3209-18. [Medline].
Traub SP. Roentgenology of Intracranial Meningiomas. Springfield, IL: Charles C Thomas Publishers;1961.
Treisch J, Schorner W, Laniado M, et al. [Characteristics of intracranial meningioma imaged by magnetic resonance tomography]. ROFO Fortschr Geb Rontgenstr Nuklearmed. Feb 1987;146(2):207-14. [Medline].
Umansky F, Pappo I, Pizov G, et al. Cystic changes in intracranial meningiomas. A review. Acta Neurochir (Wien). 1988;95(1-2):13-8. [Medline].
VanSonnenberg E, Barton JB, Wittich GR. Radiology and the law, with an emphasis on interventional radiology. Radiology. 187(2):297-303. [Medline].
Vassilouthis J, Ambrose J. Computerized tomography scanning appearances of intracranial meningiomas. An attempt to predict the histological features. J Neurosurg. Mar 1979;50(3):320-7. [Medline].
Wakhloo AK, Juengling FD, Van Velthoven V, et al. Extended preoperative polyvinyl alcohol microembolization of intracranial meningiomas: assessment of two embolization techniques. AJNR Am J Neuroradiol. May-Jun 1993;14(3):571-82. [Medline].
Walker AE, Robins M, Weinfeld FD. Epidemiology of brain tumors: the national survey of intracranial neoplasms. Neurology. Feb 1985;35(2):219-26. [Medline].
Wigertz A, Lönn S, Mathiesen T, et al. Risk of brain tumors associated with exposure to exogenous female sex hormones. Am J Epidemiol. Oct 1 2006;164(7):629-36.
Wiggli U, Elke M, Muller HR, et al. The CT pattern of meningioma: is it specific? In: Lanksch W, Kazner E, eds. Cranial Computerized Tomography. Heidelberg:. Springer-Verlag;1976: 162-6.
Yeakley JW, Kulkarni MV, McArdle CB, et al. High-resolution MR imaging of juxtasellar meningiomas with CT and angiographic correlation. AJNR Am J Neuroradiol. Mar-Apr 1988;9(2):279-85. [Medline].
Zee CS, Chin T, Segall HD, et al. Magnetic resonance imaging of meningiomas. Semin Ultrasound CT MR. Jun 1992;13(3):154-69. [Medline].
Zimmerman RD, Fleming CA, Saint-Louis LA, et al. Magnetic resonance imaging of meningiomas. AJNR Am J Neuroradiol. Mar-Apr 1985;6(2):149-57. [Medline].
Zulch KJ. Brain Tumors: Their Biology and Pathology. 3rd ed. Berlin:. Springer-Verlag;1986:85-114.
Further Reading
Keywords
meningothelioma, leptomeningioma, mesothelioma of the dura mater
