Meningioma · Observe vs Resection vs SRS

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Symptoms/size/edema/site + WHO grade
   Symptoms/growth/edema? Site/resectability? Pathology grade?
   • Asymptomatic, small, incidental (especially elderly/calcified/no edema) → Asymptomatic small → observe
   • Symptomatic/growth/marked edema/mass effect, resectable → Symptomatic/growth → surgical resection
   • Small (<3 cm), hard-to-reach (skull base/cavernous sinus)/residual-recurrent/unfit for surgery → Small/hard-to-reach/residual → SRS
   • Atypical (WHO II)/anaplastic (III) → WHO II/III → resection + radiotherapy
2. [End] Asymptomatic small → observe
   Asymptomatic small meningioma → observe (serial MRI: at 3–6–12 months then annual); manage if it grows or becomes symptomatic.
3. [End] Symptomatic/growth → surgical resection
   Symptomatic/growth/edema/mass effect → surgical resection (Simpson grade reflects extent of resection and recurrence risk); aim for gross total resection and address involved dura/bone.
4. [End] Small/hard-to-reach/residual → SRS
   Small (<3 cm), hard-to-reach (skull base/cavernous sinus), residual/recurrent, high surgical risk → stereotactic radiosurgery (SRS); fractionated radiotherapy for larger lesions near critical structures.
5. [End] WHO II/III → resection + radiotherapy
   Atypical (WHO II)/anaplastic (III) → maximal safe resection + adjuvant radiotherapy; close follow-up, high recurrence rate.

Source guidelines & references

• Meningioma management (EANO guideline; Simpson grade; NCCN CNS)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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