Does long-term ionizing radiation have an effect on intracranial meningiomas?

  Meningiomas originate from the arachnoid cells of the soft meninges and are the most common tumors of the central nervous system. Most meningiomas are located in the superior curtain, most commonly in the dural venous sinus, parsagittal sinus and pterygoid crest regions of the cerebral convexity. Approximately 98% of meningiomas are not malignant (WHO grade I or II), and approximately 2% of meningiomas are not malignant. Of the non-malignant meningiomas, 45% are diagnosed by imaging methods alone and just over half (53%) are histologically confirmed. The incidence of meningiomas increases with age, especially after the age of 65 years, and is more common in women than men.  Exposure to ionizing radiation is the strongest controllable risk factor seen in the literature. Other controllable risk factors, such as cell phone use, occupational exposure, smoking, and head trauma, remain inconclusive. Non-controllable risk factors include increasing age and gender, with a higher prevalence in females of childbearing age. Genetic and familial factors play a risk role in meningioma and are likely to be present in the development of meningioma.  Treatment of meningiomas depends on tumor size, tumor location, associated symptoms, age and health status. For symptomatic or progressively enlarging meningiomas, complete resection (if feasible) of the tumor, surrounding dural attachments, and affected bone is recommended. Most meningiomas of the cerebral convexity, spinal cord, and parafascicular meningioma can be completely resected. If total resection is not feasible, radical external irradiation and partial resection followed by adjuvant radiotherapy may be an option.  The 5-year survival rate for meningioma patients is 91.3%. Age at diagnosis and surgical resection are clinical predictors of meningioma survival. Tumors of the convex surface of the brain can be cured by surgical resection, whereas tumors of the skull base, especially those located in the oblique region or invading the cavernous sinus or orbit, usually have a poorer prognosis.  With the current trend of an aging population and following the increase in the average life expectancy of women, epidemiological statistics descend to show an increasing trend in the incidence of meningiomas. High-dose ionizing radiation exposure indicates the only known controllable risk factor for meningioma development, and indications for treatment indicate when the lesion is symptomatic or when there is a neurological problem with the lesion. Surgical procedures are the treatment of choice. Adjuvant radiotherapy should be considered for WHO grade II and III meningiomas.