gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Treatment protocol for aggressive meningiomas

Behandlungsprotokoll für aggressiv wachsende Meningeome

Meeting Abstract

  • corresponding author S. Heinze - Klinik für Neurochirurgie, Universitätsklinikum Marburg
  • A. Fahoud - Klinik für Neurochirurgie, Universitätsklinikum Marburg
  • U. Sure - Klinik für Neurochirurgie, Universitätsklinikum Marburg
  • H. D. Mennel - Abteilung für Neuropathologie, Universitätsklinikum Marburg
  • R. Engenhart-Cabillic - Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Marburg
  • H. Bertalanffy - Klinik für Neurochirurgie, Universitätsklinikum Marburg

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc09.05.-05.05

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Veröffentlicht: 4. Mai 2005

© 2005 Heinze et al.
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Although benign, meningiomas occasionally behave aggressively and are associated with a less favourite prognosis. Goal of this study was to evaluate our interdisciplinary treatment protocol (neurosurgery and radiation oncology) for meningiomas that were classified as WHO II or III.


Sixteen patients out of 201 (8,0%) who were operated on meningiomas in our department between 1997 and 2003 were classified histologically as aggressive non-benign and were studied retrospectively. A total of 20 surgical procedures was performed. Men constituted 69%, women 31% of our patients. The average age at diagnosis was 54.6 years (27-77). Clinical symptoms, pre- and postoperative radiographs, histological criteria and individual treatment protocols were analyzed for the entire group.


Radiographic findings suggestive of aggressiveness as marked peritumoural edema, cystic changes, bone or brain invasion were observed in 4/16 (25%) of our cases, mainly grade III. Thirteen atypical meningiomas (WHO II) were diagnosed and resected, 8 of them completely without further therapy. One was subtotally resected without postoperative radiotherapy according to the patient´s decision. Two patients developed recurrent tumours with no malignant progression and 2 individuals suffered from a recurrent anaplastic meningioma. These recurrent atypical menigiomas were resected and underwent fractionated stereotactic radiotherapy. In our series we treated 4 anaplastic meningiomas (2 with tumour progression from atypical) and 1 meningeal sarcoma (WHO IV). These 5 patients underwent 7 surgeries. Total excision was achieved in 4 cases. All individuals suffering from grade III tumours received postoperative stereotactic radiotherapy. We noticed a prominent focal proliferation pattern (pronounced MIB 1 positive nuclei) in some grade II and grade III tumours.


Total resection is therapy of choice for non-benign meningiomas. Subtotal resected atypical meningiomas should be additionally treated by fractionated stereotactic radiotherapy to avoid tumour growth and malignant progression. Histological findings in this limited series may call for adjuvant radiotherapy for all non-benign meningiomas with a focal proliferation pattern.