The number of patient imaging studies has increased because of precautious physicians ordering scans when a vague symptom is presented; subsequently, the number of incidental meningiomas detected has increased as well. These brain tumors do not present with related symptoms and are usually small. MRI and computed tomographic scans most frequently capture incidental meningiomas. Incidental meningiomas are managed with observation, radiation, and surgical resection. Ultimately, a conservative approach is recommended, such as observing an incidental meningioma and then only radiating if the tumor displays growth, whereas a surgical approach is to be used only when proven necessary.
Key points
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The number of patient imaging studies has increased because of precautious physicians ordering scans when a vague symptom is presented; subsequently, the number of incidental meningiomas detected has increased as well.
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These brain tumors do not present with related symptoms and are usually small. MRI and computed tomographic scans most frequently capture incidental meningiomas.
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Incidental meningiomas are managed with observation, radiation, and surgical resection.
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Ultimately, a conservative approach is recommended, such as observing an incidental meningioma and then only radiating if the tumor displays growth, whereas a surgical approach is to be used only when proven necessary.
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A conservative approach for incidental meningiomas provides the highest quality of care for patients, because lives are not subject to costly, unnecessary procedures.
Introduction
Meningiomas arise from the arachnoid caps cells on the outer surface of the meninges and are the second most common primary brain tumor. They account for 13% to 37% of all intracranial tumors. These tumors are estimated to be seen in 97.5 per 100,000 individuals per year. Diagnosis of meningiomas is more frequent in women. The Registry of the United States states that meningiomas are identified more than twice as frequently in female patients. In addition, elderly patients are detected with meningiomas at a higher frequency. The incidence rates for this tumor in 2002 for age groups of 20 to 34, 45 to 54, 65 to 74, and 85+ were 0.74, 4.89, 12.79, and 18.86 per 100,000 individuals per year, respectively. The World Health Organization (WHO) has histologically classified meningiomas into 3 grades: grade I (begin), grade II (atypical), grade III (malignant or anaplastic). The estimated prevalence of each grade is 75%, 20% to 35%, and 1% to 3%, respectively.
Incidental meningiomas are meningiomas that are found unexpectedly and without related symptoms. Physicians have seen an increase in diagnosed incidental meningiomas due to the expansive use of neuroimaging for “imaging checkups” and precautionary diagnostics. In the past few years, more asymptomatic meningiomas were found each year than symptomatic meningiomas. Table 1 lists the patient age and tumor characteristics for all English-language published articles between 2005 and 2015 that present asymptomatic meningioma data.
| Article | Number of Patients | Mean Age (y) | Tumor Size at Diagnosis | Location | |||
|---|---|---|---|---|---|---|---|
| Skull Base, n (%) | Convexity, n (%) | Falx/Parasagittal, n (%) | Other, n (%) | ||||
| Jadid et al, 2015 | 65 | 66.6 |
| 32 (49.2) | 13 (20) | 20 (30.8) | 0 (0) |
| Zeng et al, 2015 | 112 | N/A |
| 29 (25.9) | 37 (33.0) | 40 (35.8) | 6 (5.4) |
| Salvetti et al, 2013 | 42 | 53 |
| 22 (52.4) | 10 (23.8) | 8 (19.0) | 1 (2.4) |
| Jo et al, 2011 | 154 | 59.2 | Mean diameter = 1.70 cm (range: 0.7 4.0 cm) | 31 (20.1) | 51 (33.1) | 52 (33.8) | 20 (13.0) |
| Hashiba et al, 2009 | 70 | 61.6 | Mean volume = 10.4 cm 3 (range: 0.63–69.2 cm 3 ) | 7 (10.0) | 27 (38.6) | 20 (28.6) | 16 (22.9) |
| Nabika et al, 2007 | 70 | 58.3 | N/A | N/A | N/A | N/A | N/A |
| Vernooij et al, 2007 | 18 | 63.3 | N/A | N/A | N/A | N/A | N/A |
| Yano et al, 2006 | 603 | N/A | Mean diameter = 2.4 cm | N/A | N/A | N/A | N/A |
| Sonoda et al, 2005 | 16 | 74.8 a | Mean diameter = 2.5 cm (range: 1.4–5.0 cm) | 6 (37.5) | 3 (18.8) | 4 (25.0) | 3 (18.8) |
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