Non-surgical Management: Observation & Radiation

Observation:  Indications (When to observe?)

1. Patients with no symptoms (“incidental meningiomas”) of all ages

2. Patients with mild symptoms in the elderly or those patients with serious medical conditions in whom surgery carries a significant risks.

3. Patients with a long history of mild or non-progressive symptoms with tumors in the “high risk” location (e.g. hearing loss on one side)

4. Patients who strongly oppose surgery after thorough counselling

Radiation:  Indications (When to radiate?)

1. Patients who have residual tumors with documented growth, or with malignant tumor histology (i.e. WHO Grade III)

2. Patients with nonoperated tumors or recurrence not amenable to safe surgery (due to the patient’s medical condition, tumor location, or age)

3. Patients who strongly favor radiation over surgery after thorough discussion of all treatment options

4. Conventional radiation (or IMRT – ‘intensity modulated radiation therapy”) for patients with tumor size greater than 3-4 cm

5. Radiosurgery (“Gamma Knife Radiosurgery” or “Cyber Knife Radiosurgery”) for patients with tumor size less than 3 cm