Meningioma: challenges and opportunities in the fight against this brain tumor

Introduction

Meningiomas are brain tumors that originate in the meninges, the membranes that cover the brain and spinal cord. These tumors represent approximately 36.4% of all primary brain tumors and primarily affect middle-aged and older adults, with a higher incidence in women than men (Ostrom et al., 2019). Although most meningiomas are benign and slow growing, they can cause significant neurological symptoms and complications due to their location and mass effect on adjacent brain structures. In this article, we will explore current challenges in the diagnosis and treatment of meningiomas, as well as emerging opportunities to improve patient outcomes and quality of life.

Epidemiology and Risk Factors

Meningiomas are the most common primary intracranial tumors of the central nervous system. They predominantly affect adults, with a higher incidence in women. Risk factors include exposure to ionizing radiation and the presence of certain genetic conditions, such as neurofibromatosis type 2. Mobile phone use was suggested to be a risk factor, but studies have refuted this hypothesis. Only 10% represent tumors. high grade (malignant). The incidence or onset of appearance is at 45 years of age and increases with age.

Challenges in Diagnosis and Treatment

One of the main challenges in the management of meningiomas is their early detection and accurate diagnosis. Initial symptoms, such as headaches, seizures, and focal neurological deficits, may be nonspecific and similar to other neurological conditions (Goldbrunner et al., 2016). Additionally, meningiomas can grow slowly for years before symptoms become evident, making them difficult to detect early. Magnetic resonance imaging (MRI) is the preferred imaging modality for the diagnosis of meningiomas.

Once diagnosed, the treatment of meningiomas poses several challenges. This management will depend on whether the symptoms cannot be controlled medically, or whether there is significant growth evidenced by imaging studies or whether there is cerebral edema. In this situation, surgery remains the mainstay of treatment, with the aim of achieving a complete resection of the tumor and relieve symptoms (Goldbrunner et al., 2016). However, the location and extent of the tumor, as well as proximity to critical structures and the patient's condition, may limit the ability to achieve a complete resection and increase the risk of postoperative complications. Radiotherapy is used as an adjuvant treatment for residual or recurrent or inoperable meningiomas, but may be associated with long-term side effects such as cognitive impairment and brain necrosis (Rogers et al., 2015).

Recent Opportunities and Advances

Despite these challenges, there have been significant advances in understanding the biology of meningiomas and the development of new therapeutic strategies. Genomic studies have identified recurrent molecular alterations in meningiomas, such as mutations in different genes (Apra et al., 2018). These findings have paved the way for the development of targeted therapies that may offer more effective and personalized treatment options for patients with meningiomas. These advances in the alteration of these genes and histological evaluation by pathology also help to predict the type of behavior that these tumors have (benign or malignant) and the risk of recurrence after surgery.

Additionally, advances in neuroimaging techniques, such as high-field MRI and positron emission tomography (PET), have improved the ability to characterize and monitor meningiomas non-invasively (Huang et al., 2019). These techniques can help guide surgical planning, evaluate response to treatment, and detect tumor recurrence early.

Another promising area is the development of new radiotherapy approaches, such as stereotactic radiosurgery and proton beam therapy, which may offer more precise and localized treatment for meningiomas, minimizing the exposure of healthy brain tissue to radiation (Combs, 2017). These advances have the potential to improve local tumor control and reduce side effects associated with conventional radiotherapy.

Forecast

Depending on the type of meningioma, it is classified into grade 1,2 and 3 depending on the histopathological characteristics and molecular and genetic changes of the tumor, with grade 1 being the lowest recurrence after surgery (7-25%), grade 2 ( 29-52%) and grade 3 with recurrence from 50-94%, and will depend on the surgical resection of these tumors, the location and the structures that this tumor compromises. 5 years of survival is 91.3% grade 1, and the Survival for grade 2 and 3 is less than 2 years to more than 5 years depending on complete resection and use of radiotherapy.

Conclusion

Meningiomas remain a significant challenge in neuro-oncology, but they also present exciting opportunities to advance their diagnosis and treatment. Continued research into the biology of meningiomas, along with the development of targeted therapies and advanced neuroimaging techniques, has the potential to transform the management of these tumors and improve outcomes for patients. Additionally, multidisciplinary collaboration between neurosurgeons, radiation oncologists, radiologists and other healthcare professionals will be essential to provide comprehensive and personalized care to patients with meningiomas. Remember that early detection is essential to monitor or manage these tumors. Among the symptoms that we must take into account are headaches, changes in personality, loss of vision, seizures, or any neurological deficit, an appropriate study must be performed. for its diagnosis and comprehensive management.

You can consult any symptoms or if you already have a diagnosis of meningioma, which I will give you the definitive management of this condition.