These tumors are considered separately because of the difference in clinical behaviour compared to benign and atypical meningiomas. In most patients a preoperative diagnosis of malignant meningioma is not made. Therefore, the initial management decisions are the same as outlined for each location of tumor. The most important surgical consideration is to make as wide an excision as possible of the dura and/or falx around the tumor. Some patients have required multiple operations.
MRI criteria of meningioma malignancy: The criteria for malignancy of a
meningioma include: (a) significant peritumoral oedema, (b) absence of calcium
deposition, (c) nonhomogeneous contrast enhancement, (d) cysts within the lesion
and (e) poorly defined, irregular borders.
Radiation therapy is used at some point in the management of most of these patients. When to give the therapy has not been defined. When there was recurrence and the findings on the scan suggested that another total removal could be done, surgery was performed.
Most of the malignant meningiomas are the tumors involving the parasagittal region.