SRS in Incidental Meningioma: Whether to Treat and When

Although incidental brain meningiomas are becoming an increasingly common radiological finding, as yet their optimal management is still a major unknown. Numerous studies have been published on the natural course of such tumours in an attempt to understand their potential growth rate, but the choice of management strategy—whether to wait and see, or to opt for surgery or radiosurgery—must also take into account several other factors, namely the position, size and radiological appearance of the tumour; the age of the patient; and any undiscovered symptoms. From a radiological point of view, more than 63% of asymptomatic meningiomas will not grow in size. The radiological features associated with a low rate of tumour growth are the existence of calcifications and the absence of signs of surrounding oedema. However, because of their location and/or the risk of producing neurological deficits, some meningiomas, even small ones, need to be treated.