Cerebral Meningioma: Management After Incomplete Surgical Resection

When surgical resection of a cerebral meningioma does not achieve the intended clinical goals, a defined evidence-based protocol guides the next step. This page describes that protocol — the approach taken after incomplete resection.

Previous Line — Why Escalation Is Triggered

The first-line approach was surgical resection, with the intent of gross total removal — or, in high surgical-risk cases such as large skull base meningiomas, a planned subtotal resection. Escalation to this protocol applies when that intervention did not achieve sufficient relief of mass effect, neurological symptoms, or reversal of neurological and cognitive deficits.

Clinical Goal of This Protocol

Long-term local tumor control on imaging.

Treatment Approach — Partial Overview

For incompletely resected WHO grade 1 meningioma without active neurological deficits, the protocol addresses whether an observation strategy or a targeted radiation-based intervention is appropriate — with specific considerations around single-fraction versus fractionated delivery. The full criteria, sequencing, and decision algorithm are available in the structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/neuonc/noab150

Patients with incompletely resected WHO grade 1 meningiomas without neurological deficits may be managed by a watch-and-scan strategy

WHO grade 1 meningiomas should be treated by radiosurgery or fractionated radiosurgery, if surgery is not possible and treatment is needed

If the tumor cannot be treated by a single fraction, fractionated radiosurgery or standard fractionated external beam RT can be applied.

It offers long-term local control in the range of 90% after 10 years.

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