Cerebral Meningioma in Elderly or Critically Sick Patients with Contraindication to Surgery

Clinical scenario

This protocol addresses symptomatic intracranial meningioma presenting in patients who are in poor clinical condition — either elderly or critically ill — or who carry a relative or absolute contraindication for surgical resection. The tumor is small, measuring 3 cm or less in diameter, and does not produce significant mass effect.

In this population, standard surgical resection is not an immediate option. Radiosurgery (SRS) has been established as an alternative in well-defined cases with small tumors in elderly or critically sick patients, and local control of small-sized intracranial meningiomas after SRS has been shown to be comparable to Simpson Grade I resection. Where local treatment options are exhausted, further management requires a distinct approach.

Treatment approach

When no further local treatment option exists, a systemic salvage pharmacotherapy strategy targeting specific angiogenic pathways may be considered. The full structured regimen — including agent selection criteria, sequencing, and the conditions under which this approach is initiated — is available via the complete protocol.

Full regimen details, agent selection, and clinical decision pathway are in the structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/neuonc/noab150

Radiosurgery may be an alternative in patients with relative or absolute contraindications for surgery and with small tumors without mass effect, although a higher grade meningioma or a different histology cannot be entirely ruled out.

SRS has been established as an alternative therapy to surgery in well-defined cases with small tumors in elderly or critically sick patients.

Local control of small-sized intracranial meningiomas of a diameter of 3 cm or less after SRS was comparable to Simpson Grade I resection.

Pharmacotherapy using bevacizumab or multikinase inhibitors targeting VEGF receptors should only be considered if no further local treatment option exists.

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