Background

Meningioma, the term coined by Harvey Cushing, refers to a set of tumors that arise contiguously to the meninges.

Pathophysiology
Meningiomas may occur intracranially or within the spinal canal. They are thought to arise from arachnoidal cap cells, which reside in the arachnoid layer covering the surface of the brain. See the images below. Meningiomas commonly are found at the surface of the brain, either over the convexity or at the skull base. n rare cases, meningiomas occur in an intraventricular or intraosseous location. The problem of classifying meningioma is that arachnoidal cells may express both mesenchymal and epithelial characteristics. !ther mesodermal structures also may give rise to similar tumors "eg, hemangiopericytomas or sarcomas#. The classification of all of these tumors together is controversial. The current trend is to separate une$uivocal meningiomas from other less well% defined neoplasms. &ndoubtedly, advances in molecular biology will allow scientists to determine the exact genomic aberration responsible for each specific neoplasm.

Epidemiology
Frequency United States

The annual incidence of symptomatic meningiomas is approximately ' cases per ()),))) individuals. Meningiomas account for approximately ')* of all primary intracranial neoplasms. However, the true prevalence is likely higher than this because autopsy studies reveal that '.+* of individuals have undiagnosed asymptomatic meningiomas. Meningiomas are multiple in ,% -)* of cases, particularly when they associated with neurofibromatosis type ' "./'#. /amilial meningiomas are rare unless associated with ./'.0(1
International

The fre$uency of meningiomas in 2frica is nearly +)* of all primary intracranial tumors.0'1
Mortality/Morbidity

Mortality and morbidity rates for meningiomas are difficult to assess. Some meningiomas are discovered fortuitously when CT or M3 is done to assess for unrelated diseases or conditions. Therefore, some patients die with meningioma and not from it. 4stimates of the ,%year survival usually range from 5+%6-*.

2 systematic review of the literature regarding the clinical behavior of small, untreated meningiomas suggests that most meningiomas '., cm or less in diameter do not proceed to cause symptoms in the , years following their discovery. 7atients with tumors '.,%+ cm in initial si8e went on to develop new or worsened symptoms (5* of the time. Those that do cause symptoms can usually be predicted with close radiographic follow%up.0+1 Meningiomas usually grow slowly, and they may produce severe morbidity before causing death. /actors that may be predictive of a high postoperative morbidity rate include patient%related factors "eg, advanced age, comorbid states such as diabetes or coronary artery disease, preoperative neurological status#, tumor factors "eg, location, si8e, consistency, vascularity, vascular or neural involvement#, previous surgery, or previous radiation therapy.
Race

Meningiomas are more prevalent in 2frica than in .orth 2merica or 4urope. n 9os 2ngeles County, meningioma is reported more commonly in 2frican 2mericans than in others.
Sex

Meningiomas afflict women more often than men. The male%to%female ratio ranges from (:(.- to (:'.;.

The female preponderance may be less pronounced in the black population than in other groups. Meningiomas are equally distributed between boys and girls.

Age

The incidence increases with age. 2ges and corresponding incidence rates reported from '))' are as follows:

Age 0-19 years - 0.1 Age 0-!" years - 0.#" Age !$-"" years - .% Age "$-$" years - ".&9 Age $$-%" years - #.&9 Age %$-#" years - 1 .#9 Age #$-&" years - 1#.0" Age &$ years and older - 1&.&%