Last Updated: September 28, 2020
- Benign slow-growing extra-axial tumor arising from arachnoid meningothelial (“cap”) cells
- Most common primary adult intracranial neoplasm
- WHO grade I
- Overwhelming majority are supratentorial (~90%): parasagittal, convexity, sphenoid wing, olfactory groove
- Infratentorial (~10%): most commonly within the cerebellopontine angle (CPA) cistern
- Optic nerve sheath or intraventricular locations may be seen
- Uncommonly arise extracranially: sinonasal, parotid, intraosseous, or skin
- Single or multiple
- Associated with neurofibromatosis type 2 (NF-2)
- “Tumor-to-tumor” metastases to meningioma may be seen (“collision tumor”), most commonly from breast or lung
- Adults (40–60 years old) are most commonly affected; children in cases of NF-2
- Female gender predilection (male/female ratio, 1:2–3)
- Presenting symptoms depend on tumor size and location
- Majority of typical meningiomas are asymptomatic
- Mass effect on adjacent structures resulting in seizures, hemiparesis, visual field defects, cranial nerve defects
- Treatment: serial imaging if small, asymptomatic; surgical resection including dural tail if symptomatic
- Well-marginated, smooth, extra-axial mass with broad dural attachment
- ±Bucking or hyperostosis of adjacent cortex
- Avid, homogeneous enhancement is typical
- Intraosseous extension and dural venous sinus involvement or compression may be present
- Well-marginated, isodense to hyperdense mass with broad dural attachment
- Variable patterns of calcification common (focal, diffuse, rim, etc)
- Hypodense peritumoral edema sometimes present
- ±Hyperostosis of adjacent bone
- T1WI: isointense to hypointense mass; hyperintense areas of calcification
- T2WI: variable signal intensity; ±cystic areas and hyperintense “cerebrospinal fluid (CSF) cleft” separating tumor from adjacent brain
- FLAIR: hyperintense peritumoral edema can be present
- T2*GRE: hypointense signal “blooming” related to calcification
- DWI: variable reduction in diffusivity
- T1WI+C: avid, homogeneous enhancement; ±dural tail (nonspecific finding)
- MR venography: evaluate patency and involvement of dural venous sinuses
- MRS: elevated alanine at short echo times results in triplet peaks at 1.3–1.5 ppm
- MRI without and with intravenous contrast; MRS might be helpful in differentiating from other tumor types if ambiguous
For more information, please see the corresponding chapter in Radiopaedia.
Contributor: Rachel Seltman, MD
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