Indications for surgery in patients with asymptomatic meningiomas based on an extensive experience

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To determine the indications for surgery in patients harboring asymptomatic meningiomas, the authors retrospectively analyzed the natural course and surgical outcome of asymptomatic meningiomas and then compared these to the natural course and surgical outcome of symptomatic meningiomas.


Between 1989 and 2003, 1434 patients harboring meningiomas, who were treated in Kumamoto Prefecture, Japan, were enrolled in this study. Six hundred three patients had asymptomatic lesions and 831 had symptomatic ones. The authors analyzed the sizes of the lesions at detection, their growth over time, and any appearances of symptoms associated with previously asymptomatic meningiomas. The authors then compared the surgery-related morbidity rates associated with asymptomatic and symptomatic meningiomas arising at different locations.

Of the 603 asymptomatic meningiomas, 351 (58.2%) were treated conservatively. Tumor growth was observed in 25 (37.3%) of 67 patients who participated in follow up for longer than 5 years, and symptoms developed in 11 (16.4%) of the 67 patients over a mean follow-up period of 3.9 years. Among the 213 patients with surgically treated asymptomatic meningiomas, the morbidity rate was 4.4% in patients younger than 70 years of age and 9.4% in those 70 years of age or older. Although the total morbidity rate was lower in patients with asymptomatic lesions than in those with symptomatic ones, it exceeded 6% in patients whose asymptomatic tumors were located at the convexity or falx.


Approximately 63% of asymptomatic meningiomas did not exhibit tumor growth, and only 6% of all patients with these lesions experienced symptoms during the observation period. To avoid surgery-related incidences of morbidity in patients with asymptomatic meningiomas, conservative treatment with close follow-up review may be the best therapeutic strategy.

Abbreviation used in this paper:MR = magnetic resonance.
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Contributor Notes

Address reprint requests to: Shigetoshi Yano, M.D., Department of Neurosurgery, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University Graduate School 1-1-1 Honjo, Kumamoto, 860-8556, Japan. email:

© AANS, except where prohibited by US copyright law.

  • 1

    Arienta CCaroli MCrotti FVillani R: Treatment of intracranial meningiomas in patients over 70 years old. Acta Neurochir (Wien) 107:47551990

    • Search Google Scholar
    • Export Citation
  • 2

    Awad IAKalfas IHahn JFLittle JR: Intracranial meningiomas in the aged: surgical outcome in the era of computed tomography. Neurosurgery 24:5575601989

    • Search Google Scholar
    • Export Citation
  • 3

    Chan RCThompson GB: Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. A retrospective study in 257 cases. J Neurosurg 60:52601984

    • Search Google Scholar
    • Export Citation
  • 4

    Cornu PChatellier GDagreou FClemenceau SFoncin JFRivierez M: Intracranial meningiomas in elderly patients. Postoperative morbidity and mortality Factors predictive of outcome. Acta Neurochir (Wien) 102:981021990

    • Search Google Scholar
    • Export Citation
  • 5

    Djindjian MCaron JPAthayde AAFevrier MJ: Intracranial meningiomas in the elderly (over 70 years old). A retrospective study of 30 surgical cases. Acta Neurochir (Wien) 90:1211231988

    • Search Google Scholar
    • Export Citation
  • 6

    Firsching RPFischer APeters RThun FKlug N: Growth rate of incidental meningiomas. J Neurosurg 73:5455471990

  • 7

    Go RSTaylor BVKimmel DW: The natural history of asymptomatic meningiomas in Olmsted County, Minnesota. Neurology 51:171817201998

    • Search Google Scholar
    • Export Citation
  • 8

    Herscovici ZRappaport ZSulkes JDanaila LRubin G: Natural history of conservatively treated meningiomas. Neurology 63:113311342004

    • Search Google Scholar
    • Export Citation
  • 9

    Krampla WNewrkla SPfisterer WJungwirth SFischer PLeitha T: Frequency and risk factors for meningioma in clinically healthy 75-year-old patients: results of the Transdanube Ageing Study (VITA). Cancer 100:120812122004

    • Search Google Scholar
    • Export Citation
  • 10

    Kuratsu JKochi MUshio Y: Incidence and clinical features of asymptomatic meningiomas. J Neurosurg 92:7667702000

  • 11

    Nakamura MRoser FMichel JJacobs CSamii M: The natural history of incidental meningiomas. Neurosurgery 53:62712003

  • 12

    Nakasu SHirano AShimura TLlena JF: Incidental meningiomas in autopsy study. Surg Neurol 27:3193221987

  • 13

    Niiro MYatsushiro KNakamura KKawahara YKuratsu J: Natural history of elderly patients with asymptomatic meningiomas. J Neurol Neurosurg Psychiatry 68:25282000

    • Search Google Scholar
    • Export Citation
  • 14

    Olivero WCLister JRElwood PW: The natural history and growth rate of asymptomatic meningiomas: a review of 60 patients. J Neurosurg 83:2222241995

    • Search Google Scholar
    • Export Citation
  • 15

    Yoneoka YFujii YTanaka R: Growth of incidental meningiomas. Acta Neurochir (Wien) 142:5075112000

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