This protocol addresses patients in whom a spinal cord meningioma has been discovered incidentally on imaging, with no neurological symptoms and no evidence of spinal cord compression or mass effect.
Observation is the first therapeutic option for asymptomatic patients with a newly diagnosed or slow-growing meningioma. When a tumour is found incidentally and the patient remains neurologically intact with no mass effect, the initial management strategy of choice is active surveillance with periodic imaging — not immediate intervention.
Should the clinical picture change, a surgical approach becomes the primary option. The complete protocol defines the specific thresholds and decision points governing that transition, along with the type of surgical goal pursued. When therapy is undertaken, clinical aims include the potential reversal of neurological and cognitive symptoms and signs.
Observation should be selected as the first therapeutic option in asymptomatic patients with newly diagnosed or slow growing meningiomas.
In case of incidentally diagnosed and asymptomatic tumors observation by annual MRI initially is the management strategy of choice (evidence level III, recommendation level C).
Therapy is indicated in symptomatic or growing meningiomas with surgery being the first option for the following reasons: the patient can often be cured by Simpson grade I resection, neurological and cognitive symptoms and signs may be reversed, tissue-based diagnosis can be made, tissue is gained for molecular pathologic testing.
DOI: 10.1093/neuonc/noab150
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