Whether to treat and how best to treat meningiomas depends on a variety of factors, including the size and location of the tumor, symptoms, growth rate and the age of the patient (among others). In general, there are three basic options: observation, surgical resection and radiation therapy. Observation: Meningiomas usually grow slowly, increasing only 1-2 mm per year. Annual review of MRI scans may be appropriate in patients with small tumors and mild or minimal symptoms, with no impact on quality of life and little or no swelling in adjacent brain regions, and in older patients with slow progression of symptoms who can control associated seizures with medications. Surgery: Meningioma surgery ranges from relatively simple to highly complex, sometimes requiring the collaboration of multiple surgeons from different specialties. The ease of surgery depends on the accessibility of the tumor and the skill of the neurosurgeon. The goals of surgery are to: 1. Obtain tissue to confirm the diagnosis Meningiomas are divided into three categories by pathology: Grade 1 – benign: These very slow tumors account for 75% of all meningiomas. Grade 2 – atypical: usually slow growing but can recur. Grade 3 – Mesenchymal: more malignant and grows more rapidly. 15% of recurrent meningiomas often progress to higher grades. grade 2 and 3 tumors recur more frequently than grade 1. 2. remove enough tumor to relieve pressure or deformation of normal brain tissue When complete removal of the tumor carries a high risk (reduced quality of life), it is preferable to leave some tumor tissue in an appropriate location. If the tumor invades a large draining vein, a major artery on the surface of the brain, or if it is on a deeper surface of the brain, the chance of complete resection is reduced and the risk of complications is increased. 3. Preservation and/or improvement of neurological function Removal of all tumors, if possible as well as safe, so that they do not recur. Meningiomas that are close to the surface and do not invade deep structures or major blood vessels are more likely to be removed safely and completely. Radiation therapy For patients who are not candidates for surgery or whose surgical resection is incomplete, conventional radiation therapy or stereotactic radiosurgery can slow or stop the growth of meningiomas. Radiation therapy is generally considered a better option for deep, surgically inaccessible tumors or for tumors in older patients. In younger patients (<50 years), the risk of radiation-induced cancer needs to be considered 10 years or more after radiation therapy. However, this appears to occur at a relatively low rate.