Table 3.
Key Recommendations
| Statement | Evidence Class2 | Recommendation Level |
|---|---|---|
| Diagnosis | ||
| Radiological diagnosis of meningiomas should be made by MRI | 4 | GPP |
| Somatostatin receptor II directed PET offers detection of meningioma with high sensitivity and specificity and should be obtained if tumor extension or the diagnosis of recurrence is uncleara | 3 | C |
| Tissue should be gained for molecular analysis, which has proven to be prognostically relevant and offers potential for future targeted therapyb | 4 | GPP |
| Therapy | ||
| Observation should be selected as the first therapeutic option in asymptomatic patients with newly diagnosed or slow growing meningiomas | 3 | C |
| Neurocognition addressing memory, attention, and executive functions should be assessed and integrated in decision makinga | 3 | C |
| HRQoL might be compromised after therapy and should be respected for any therapeutic indicationa | 4 | GPP |
| Surgery should be considered as the first therapeutic option in tumors of all WHO grades if therapy is indicated | 3 overwhelming | B |
| Goal of surgery is gross total resection according to Simpson Grade I whenever safely feasible | 3 overwhelming | B |
| Radiosurgery should be considered as an alternative to surgery in small tumors, in specific locations, and in specific clinical situations, if tissue collection seems not mandatory | 3 | C |
| WHO grade 1 meningiomas should be treated by radiosurgery or fractionated radiosurgery, if surgery is not possible and treatment is needed | 2 | B |
| Patients with incompletely resected WHO grade 1 meningiomas without neurological deficits may be managed by a watch-and-scan strategya | 3 | C |
| Patients with recurrent or atypical meningiomas should receive fractionated radiotherapy | 2 | B |
| The combination of intended subtotal surgery and radiosurgery or fractionated radiotherapy in WHO grade 1 meningiomas should be considered for comprehensive tumor treatment with reduced risk of tumor progression | 3 | C |
| Radical surgery and fractionated radiotherapy should be performed in WHO grade 3 meningiomas | 3 overwhelming | B |
| Pharmacotherapy using bevacizumab or multikinase inhibitors targeting VEGF receptors should only be considered if no further local treatment option existsb | 3 | C |
| Follow-up | ||
| Follow-up of WHO grade 1 meningiomas should be performed by MRI every 12 months, after 5 years every 2 years | 4 | GPP |
| Follow-up of WHO grade 2 meningiomas should be performed by MRI every 6 months, after 5 years every 12 months | 4 | GPP |
| Follow-up of WHO grade 3 meningiomas depend on clinical progression and should be done at least every 3-6 months | 4 | GPP |
Abbreviations: GPP, good practice point; HRQoL, health-related quality of life; MRI, magnetic resonance imaging; PET, positron emission tomography; VEGF, vascular endothelial growth factor.
aNew key recommendation since 2016.
bStrongly modified key recommendation since 2016.