Initial Management at Presentation
- Surgery is preferred initial treatment: Surgery is almost always the initial treatment for meningiomas in children. It will allow an accurate diagnosis and in most cases a complete resection is sufficient for the tumor’s management.
- Goal is complete excision: Except for tumors that are closely approximated to major nerves or blood vessels, or are clearly invasive of the brain as in the case of malignant or some atypical meningiomas, the goal of surgery should be complete excision. Tumors around the optic nerve or cavernous sinus would be the obvious exceptions, and in these cases close follow-up and radiation therapy are probably a better option than causing surgical morbidity.
- Radiotherapy: Radiotherapy is needed for those tumors that cannot be removed entirely or if they are high grade.
- Chemotherapy: There is no proven efficacy of chemotherapy in meningioma treatment.
- Frequency of visits: The first visit is usually 2-4 weeks postoperatively, then according to center protocol. More frequent visits are required if residual tumor or atypical tumor is present. It is cautious to recommend follow-up visits every 3 months for the first year, but this schedule may not always be feasible or necessary.
- Frequency of scans: Generally, there should be an immediate postoperative scan should be obtained within 48 hours. Baseline imaging is done 3 months after resection. Subsequent imaging is a function of risk recurrence and ease of scanning. At the author’s institution imaging for tumors is generally repeated every 3-6 months for 2 years postoperatively, then annually thereafter until about 5 years postoperatively.
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