title: Review of controversies in management of non-benign meningioma.
abstract: Meningiomas are one of the most common brain tumors. World Health Organisation (WHO) Grade II and Grade III meningiomas are grouped together as non-benign meningioma (NBM). There are several controversies surrounding NBM management, including the significance of extent of resection and the efficacy of post-operative radiation and drug treatment. We reviewed the literature to develop recommendations for management of NBM. The questions we sought to answer were: Does gross total resection (GTR) improve patient outcome? Is radiation therapy (RT) warranted after complete or after incomplete resection of NBM? What drug therapies have been proven to improve outcome in patients with NBM? We found that GTR improves outcome in WHO Grade II meningioma, and should be attempted whenever considered safe. GTR correlates less closely to outcome in Grade III meningioma compared to subtotal resection (STR). Extreme measures to completely resect Grade III meningioma are not warranted. RT following GTR of Grade II meningioma does not improve patient outcome, and may be reserved for recurrence. RT improves outcome following STR of Grade II meningioma. RT improves outcome after resection of Grade III meningioma. No drug therapy has been shown to improve outcome in NBM. This review elucidates recommendations for some of the controversies involving NBM.
authors.affiliation: The Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3052, Australia. Electronic address: iddo.paldor@mh.org.au.
authors.forename: Iddo
authors.initials: I
authors.lastname: Paldor
authors.affiliation: The Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3052, Australia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Awad
authors.affiliation: The Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3052, Australia.
authors.forename: Yuval Z
authors.initials: YZ
authors.lastname: Sufaro
authors.affiliation: The Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3052, Australia.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Kaye
authors.affiliation: The Department of Neurosurgery, Hadassah Medical Center, Ein-Kerem Campus, Jerusalem 91120, Israel.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Shoshan
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D008579:Meningioma / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D009364:Neoplasm Recurrence, Local
chemical_list: D000970:Antineoplastic Agents
keywords: Anaplastic meningioma; Atypical meningioma; Drug therapy; Extent of resection; Radiation therapy