Meningioma is one of the more common tumors in the central nervous system, and the most common intra-axial tumor. Meningioma accounts for almost 25% of all brain tumors and more than 45% of all intracranial neoplasms. In most cases, MMTs are benign and are curable. Meningioma was the most common cause of death due to intra-axial tumors in the United States in 2014. However, despite this high prevalence, there is no specific imaging test which is sensitive enough to exclude MMTs from a broad differential diagnosis. It is prudent to rule out MMTs in patients presenting with focal mass-effect and hemifacial pain.
Genetic factors play a major role in the development of meningioma. The rate of development is affected by the age of the patient at the moment of diagnosis. A second major risk factor for developing meningioma is the long-term use of oral contraceptive pills.
Meningiomas are not always curable but can be highly debilitative in most cases. The patient's history of neurological symptoms as well as MRI appearance help in predicting whether a patient can still function after treatment.
A clinician should be concerned about meningioma at most points of time. Patients with a meningioma should consult their physician on a regular basis and should be assessed by a neurologist with special expertise in neurooncology or a neurosurgeon.
The most common treatment strategy for meningioma is surgery. The effectiveness of surgical intervention in achieving a cure is questionable, as many patients who have had surgery do not survive long. Survival is better in patients with smaller tumors with a good grade. Surgery usually has a good surgical outcome, in part because the surgeon can often achieve total gross removal if the tumor is small. Radiosurgery can be used successfully to manage tumors of some size, and radiosurgery may be a first, or second, option for large tumors. Radiosurgery may be successful because surgery may allow the tumor cell to grow as a new, distinct tumor. This process may make it harder to define whether partial removal of a tumor still achieves a cure.
Approximately 1.4 million women get meningioma a year in the United States. This number can be further increased if meningioma cases are counted from diagnostic biopsies performed on women at the end of their menstrual cycle. If meningioma is added as a separate diagnosis to all other benign tumors, the cumulative total of meningiomas diagnosed could be 6.4 million women.
We found no significant differences between cohorts regarding quality of life. Follow-up studies with larger patient cohorts are warranted to compare patients treated with DOTA-CHX and those receiving DOTA-TOC.
Although most patients with a meningioma can be discharged with minimal treatment, some may require prolonged hospitalization or surgical intervention. However, the likelihood of morbidity, mortality, and return to hospital is greater in patients with extracranial complications, such as a ruptured aneurysm, and those patients who are older, who are female, or who are in the first decade of life. Therefore, it seems prudent to consider all the factors involved before deciding to discharge patients to the short-stay unit.
Ga-68 DOTATOC has been shown to be useful in the diagnosis of meningioma with a sensitivity of approximately 98-99% and a specificity of 90-100%. Other studies are warranted.
Overall, gGa-68-dotatoc is well tolerated by most healthy adults. The observed effects of gGa-68-dotatoc exposure would not be clinically important for most people. No significant effects on key cardiorespiratory functions were found for most individuals following single 30 MBq intravenous (3.0 mCi) gGa-68-dotatoc administration, with no evidence of any significant accumulation in any organs. All adverse events were mild and transient.
It is clear that meningioma is a genetic disorder with complex pattern of inheritance. The observed high prevalence of migraine as well as the association of meningioma with glioma point to linkage to a recessive, autosomal dominant or X chromosome-linked gene.
Ga-68-dotatoc (Gallium 68-DOTA) is the technetium analogue that results in a very long PET scan, and can be used with PET/CT scans. The uptake of Gallium 68 by the tumor and the distribution of positron emitting radiotracer in patients with neurosurgical treatment of glial tumors can be used to help identify the origin of this tumour.