Molecular findings of incidental meningioma may shape clinical management

Incidental discovery of an asymptomatic meningioma is increasingly encountered by neurosurgeons, neuro-oncologists, and neurologists. Between 2000 and 2019, the incidence of meningioma diagnosed by imaging alone rose from 14.0 to 70.2 per 1 000 000 individuals in the Netherlands,1 and a similar trend has been observed in the United States.2 With improving life expectancy and an aging population, the number of these diagnoses is expected to increase further. The key question underpinning management is: will the meningioma grow and become symptomatic such that it requires intervention during an individual’s lifetime? Several studies have addressed this by demonstrating that most incidental meningiomas are indolent and slow-growing, with an estimated symptomatic progression rate of 5%-10%. Furthermore, MRI features such as T2 signal hyperintensity and larger tumor size at presentation may aid patient selection for more frequent or prolonged surveillance.3 Despite these findings, current management guidelines continue to recommend prolonged radiological surveillance to distinguish growing from non-growing tumors.4