Incidentally discovered meningiomas, a single institute case series with different management options

Abstract Background The incidence of incidentally discovered meningiomas has been increased nowadays due the widespread and the more availability of modern imaging machines. Their management represents a challenge for neurosurgeons. Objectives This retrospective clinical case study aimed to study both the clinical and radiological findings and final outcome of such lesions. Patients and methods This study has been conducted upon 23 patients who had incidentally discovered meningiomas during the period from January 2015 to December 2020. All patients had been followed clinically and radiologically. Any development of clinical manifestations or radiological growth of the lesions had been documented. Results 23 patients (13 females and 10 males) with a mean age of 58 years have been included. The mean initial tumor size was 1.9 ± 0.45 cm. The patients were divided into 2 groups; Group A (16 patients) who had completed the 5 years follow-up period successfully without the need for any intervention, and Group B (7 patients) for those patients who’s the initial follow-up decision was changed and required either radiosurgery (4 patients) or microsurgery (3 patients). For Group A, the mean annual absolute growth rate (AGR) was 0.26 ± 0.24 mm/year. All of the 16 lesions were either hypointense (9/16) or isointense (7/16) on the initial T2-weighted MRI scans. 9/16 patients have different patterns of calcifications in the initial CT scans. For Group B, the mean annual AGR was 4.23 ± 2.9 mm/year. The 7 lesions were hyperintense on initial T2-weighted MRI scan, and none of them has calcifications in the initial CT scans. According to the AIMSS system, the mean score for Group A was 1.75 ± 1.85 (range 0–4), while it was 5.7 ± 2 (range 4–8) for group B. Conclusion Incidentally discovered meningiomas are usually of small size at time of diagnosis and tend to grow slowly over a long period of time and need careful active monitoring.