This protocol addresses symptomatic or growing spinal cord meningioma in a patient who is in good clinical condition. The primary treatment for symptomatic or enlarging meningiomas is surgery, and surgery should be considered the first therapeutic option in tumours of all WHO grades when treatment is indicated.
First-line management pursues gross total resection of all involved dura and bone (Simpson grade I), targeting relief of neurological symptoms, reversal of mass effect, and recovery of cognitive and neurological function.
When surgical resection does not fully achieve these goals — leaving residual tumour, incomplete resection, or when the meningioma recurs — this protocol defines the next clinical step.
For patients with residual, incompletely resected, or recurrent disease, or with higher-grade tumour histology, adjuvant radiation-based treatment plays a central role. The approach differs by resection extent, WHO grade, and anatomical location. The clinical goal is reduction of tumour size on imaging and sustained local control.
DOI: 10.1093/neuonc/noab150
The primary treatment for the majority of symptomatic or enlarging meningiomas is surgery.
Surgery should be considered as the first therapeutic option in tumors of all WHO grades if therapy is indicated.
Residual meningioma can then be monitored or treated with postoperative conformal fractionated RT or stereotactic radiosurgery (SRS).
Patients with recurrent or atypical meningiomas should receive fractionated radiotherapy.
For WHO grade 2 meningioma with a Simpson IV-V resection, RT is recommended.
Radical surgery and fractionated radiotherapy should be performed in WHO grade 3 meningiomas.
There are little data for radiosurgery of spinal meningiomas which can be performed as single-dose radiosurgery or in a hypofractionated manner, too.
Two retrospective series found that a reduction of tumor size after SRS or hypofractionated RT was predictive for long-time tumor control after 5 and 10 years.
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