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Incidental meningiomas

Roukoz Chamoun, Khaled M. Krisht, and William T. Couldwell

abnormalities were found, and 19 of them were meningiomas (prevalence 0.52%). 35 In a more recent prospective population-based study in the Netherlands involving 2000 people who were 45 years of age or older, the prevalence of benign brain tumors was 1.6%, with meningiomas as the most common (0.9%). 31 These meningiomas ranged from 5 to 60 mm in diameter, and their prevalence was 1.1% in women and 0.7% in men. The study also detected an increase in prevalence from 0.5% in patients 45–59 years old to 1.6% in those 75 years old or older. With the discovery of these

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Targeted drug therapy for meningiomas

Andrew D. Norden, Jan Drappatz, and Patrick Y. Wen

M eningiomas are primary central nervous system tumors composed of neoplastic meningothelial (arachnoid cap) cells. 68 They represent the most common type of benign intracranial tumor. With an annual incidence of approximately 2.3 to 6 per 100,000 persons, meningiomas account for approximately 13 to 26% of primary brain tumors in adults. 7 , 26 , 74 , 135 Many meningiomas are asymptomatic in life and are found incidentally in 1.4% of autopsies. 74 They occur twice as often in women as in men, and the mean age of patients at diagnosis is approximately 58

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Meningiomas: causes and risk factors

Jill S. Barnholtz-Sloan and Carol Kruchko

M eningiomas account for 30% of all primary brain tumor diagnoses in adults in the United States. 9 The overall age-adjusted incidence rate is 4.52 per 100,000. 9 Although age-adjusted incidence rates are reportedly similar across racial groups, the incidence in women is approximately twice that in men ( Table 1 ). 9 The incidence increases with increasing age, peaking in the seventh and eighth decades of life; these tumors are very rare in children ( Fig. 1 ). 9 It is currently estimated that 83% of all meningiomas are microscopically confirmed. 36

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The molecular genetics and tumor pathogenesis of meningiomas and the future directions of meningioma treatments

Winward Choy, Won Kim, Daniel Nagasawa, Stephanie Stramotas, Andrew Yew, Quinton Gopen, Andrew T. Parsa, and Isaac Yang

M eningiomas are the second most common adult neoplasm of the CNS, and they are mostly benign, slow-growing tumors originating from the arachnoidal cap cells. 97 The annual incidence of meningiomas is 2.3 per 100,000, increases with age, and peaks in the 7th decade of life. 97 , 98 Overall incidence is greater in females with a 2:1 ratio, yet higher grade meningiomas are more frequent in males. 36 , 67 Deletions of the neurofibromatosis Type 2 (NF2) gene, ionizing radiation, and head trauma are associated with an increased risk, while the role of sex

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Stereotactic radiation treatment for benign meningiomas

Andrew E. H. Elia, Helen A. Shih, and Jay S. Loeffler

M eningiomas account for 15 to 25% of all primary brain tumors and have a reported annual incidence between one and 10 per 100,000. 47 Surgery is the preferred treatment for benign meningiomas whenever complete resection can be achieved with reasonable morbidity, resulting in 5-, 10-, and 15-year PFS rates of 93, 80, and 68%, respectively. 31 However, complete resection is not possible in 20 to 30% of presenting patients. 31 , 42 In these cases, subtotal resection has inferior results, with 5-, 10-, and 15-year PFS rates of 63, 45, and 9%, respectively

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Hydroxyurea chemotherapy in the treatment of meningiomas

Herbert B. Newton

Introduction and General Overview Meningiomas are usually slow growing, benign tumors of extraaxial origin that arise from the arachnoidal cap cells associated with the arachnoid villi at the dural venous sinuses, cranial nerve foramina, cribiform plate, and medial middle fossa. 4 , 6 , 9 , 36 Meningiomas are classified by their site of origin within the nervous system, which is most commonly the intracranial cavity. In adults 85 to 90% of tumors occur supratentorially, with 30 to 40% arising along the base of the anterior and middle fossae. 50 The most

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Stereotactic radiosurgery for meningiomas

Lawrence S. Chin, Nicholas J. Szerlip, and William F. Regine

Meningiomas are benign tumors attached to the dura that typically have a slow growth rate. After gliomas, they are the most common primary tumor of the brain. They are ideal radiobiological targets because single-fraction radiation has a high biologically effective dose. Furthermore, a highly conformal radiation plan can provide effective treatment to the tumor while sparing the surrounding brain. Meningioma control rates range from 90 to 95%, and the risk of morbidity is low. Radiosurgery is an excellent treatment for asymptomatic, small- to moderate-sized meningiomas. It is also ideal for patients with incompletely resected meningiomas, recurrent meningiomas, and risk factors precluding conventional surgery.

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Treatment of unresectable skull base meningiomas with somatostatin analogs

Chris Schulz, René Mathieu, Ulrich Kunz, and Uwe Max Mauer

M eningiomas represent around 20% of all intracranial tumors and have a 10-year recurrence rate of 20%–50% despite aggressive surgery and irradiation. 14 The standard surgical treatment for meningiomas is total resection. However, many tumors are not amenable to surgery given their deep location or proximity to delicate structures. 25 The complete removal of skull base meningiomas can be especially difficult when basal vessels and cranial nerves are involved. For inaccessible tumors and those with aggressive histological or clinical features, radiation

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Current standing and frontiers of gene therapy for meningiomas

Rafael De la Garza-Ramos, Jessica V. Flores-Rodríguez, Juan Carlos Martínez-Gutiérrez, Alejandro Ruiz-Valls, and Enrique Caro-Osorio

M eningiomas are typically slow-growing tumors of the central nervous system (CNS) that originate from arachnoid cap cells, which belong to the outermost layer of the arachnoid mater. Meningiomas are the second most common primary adult neoplasm of the CNS after glioblastoma multiforme (GBM), with an annual estimated incidence of 2.3 cases per 100,000 persons. 71 , 72 Most of these tumors are considered benign, but although 5-year survival rates reach 90%, 20-year survival rates are approximately 53%. 80 Intracranial meningiomas represent 98% of all CNS

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Controversies in the role of preoperative embolization in meningioma management

Amit Singla, Eric M. Deshaies, Vlad Melnyk, Gentian Toshkezi, Amar Swarnkar, Hoon Choi, and Lawrence S. Chin

T he debate concerning preoperative embolization of meningiomas continues 4 decades after the procedure was first described by Manelfe et al. 20 Although some data suggest that preoperative embolization may have benefits such as decreased blood loss and “softening of the tumor” during subsequent resection, the overall outcomes are still controversial. The pros of preoperative embolization, including less intraoperative blood loss and facilitation of surgery, have to be carefully weighed against the cons of an additional intervention, with its inherent