Meningiomas: Multidisciplinary approach for optimal care

July 25, 2025

Mayo Clinic has a large team of experts focused on caring for people with meningiomas. Multiple specialists work together enterprise-wide to provide cutting-edge, personalized management.

"These tumors require multidisciplinary care: excellent neuro-oncology, neurosurgery and radiation oncology. That's the real strength we bring to meningioma treatment," says Alyx B. Porter, M.D., a neuro-oncologist at Mayo Clinic in Phoenix/Scottsdale, Arizona.

Optimal treatment approaches vary, depending on a tumor's characteristics and the patient's needs. "We prioritize making sure that patients undergo whatever treatment they really need. The close partnership between our specialists allows us to plan the best approach — whether surveillance, surgery, radiation or a combination," says Victoria E. Clark, M.D., Ph.D., a neurosurgeon at Mayo Clinic in Jacksonville, Florida.

As a major brain tumor center, Mayo Clinic also is at the leading edge of finding innovative treatments for meningioma. These efforts use multiplatform molecular data to build predictive modeling of tumor behavior.

"Genomic, methylation and other testing is transforming care for patients," says Gelareh Zadeh, M.D., Ph.D., chair of Neurosurgery at Mayo Clinic in Rochester, Minnesota, and founder of the International Consortium on Meningiomas (ICOM). "The motivation behind our research is to maximize patient outcomes and allow for patients to make better informed decisions about their brain tumor care."

Launched in 2016, ICOM has 52 institutions working together to better understand treatment options, meningioma biology that can guide management, and the most up-to-date indications for treatment. ICOM has published on guidelines, new therapeutics and novel discoveries for meningioma classification. The consortium meets to ensure that cutting-edge research findings are implemented in patient care.

Expert imaging and treatment

Meningiomas, the most common primary brain tumors, are generally benign and slow growing. Small, grade 1 tumors might be an incidental finding. "A subset of patients won't need any treatment for their meningiomas, other than periodic monitoring for tumor growth or the development of symptoms," Dr. Porter says.

However, sometimes even small meningiomas can compress surrounding structures and cause symptoms, such as vision or hearing problems and facial weakness or pain. Depending on the tumor location, a meningioma also might cause seizures, memory loss or trouble speaking. "In some severe cases, the neurologic deficit can be quite devastating for patients and prevent them from working or performing independent living activities," Dr. Porter says.

"We prioritize making sure that patients undergo whatever treatment they really need."

— Victoria E. Clark, M.D., Ph.D.

Symptomatic tumors generally require treatment. At Mayo Clinic, neurosurgeons and radiation oncologists work together to determine whether a tumor would be treated best with surgery, radiation or both. "The surgery can be made significantly safer if the small portions that are absolutely highest risk — including those that invade into critical venous structures, such as the cavernous sinus — are left unresected and treated with radiation later," Dr. Clark says.

At Mayo Clinic, state-of-the-art imaging guides the optimal treatment approach. 68-Ga-DOTATATE PET, a new technology, visualizes areas where meningiomas express somatostatin receptors.

Sensitivity and specificity in imaging

Neurofibromatosis type 2-related meningiomas and schwannomas in a 17-year-old patient. A. Sagittal postcontrast image reveals multiple enhancing convexity, parasagittal and posterior fossa meningiomas. B. Multiple schwannomas are seen on the axial postcontrast image, including a large left vestibular schwannoma, small right vestibular schwannoma (white arrow) and multiple small schwannomas within the left Meckel cave (black arrow). C and D. 68-Ga-DOTATATE PET scan reveals multiple variable-sized meningiomas in the supra- and infratentorial region, including a left-sided intraventricular meningioma (white arrow).

"That provides high sensitivity and specificity for tumor detection," says Neetu Soni, M.B.B.S., M.D., a neuroradiologist at Mayo Clinic's campus in Florida. "Compared with conventional MRI, 68-Ga-DOTATATE PET is particularly helpful for delineating tumor extent in complex locations such as the skull base, intraosseous sites and regions adjacent to critical neurovascular structures."

The technology better guides surgical and radiotherapy planning and differentiation of meningiomas from histologic mimics and postoperative changes. "68-Ga-DOTATATE PET also enhances detection of residual or recurrent disease not visualized on MRI, which helps improve risk stratification and inform adjuvant therapy decisions," Dr. Soni says. Dr. Soni is the lead author of a review published in the American Journal of Neuroradiology that describes the evolving landscape of imaging and genetic biomarkers in meningiomas.

When needed, meningioma resections are performed by subspecialized, highly experienced skull base surgeons. Even large tumors can be successfully treated. "We've had a lot of patients with large frontal meningiomas who tell us after surgery that they feel the best they have in 20 years," Dr. Clark says. "They feel like themselves again."

When radiation is needed, Mayo Clinic's campuses in Arizona and Minnesota offer proton beam therapy. Mayo Clinic's campus in Florida is due to offer proton beam therapy in 2026.

"Proton beam radiation gives us pinpoint accuracy," Dr. Porter says. "We can tailor the radiation to the tumor and avoid side effects from radiation to healthy tissue. That can make a big difference."

Options for targeted medical therapy

At Mayo Clinic, neuropathologists analyze meningiomas to determine their genetic makeup. That information helps guide targeted medical therapy for individuals with grade 2 or grade 3 meningiomas. Medical therapy is especially important when high-grade meningiomas recur after surgery.

"The number of times patients can receive radiation is limited. In those situations, medication might help prevent tumor growth," Dr. Porter says.

Bevacizumab, a vascular endothelial growth factor (VEGF) antibody, might be used to treat meningiomas that express VEGF. Octreotide, an analog of somatostatin, is another Food and Drug Administration-approved potential treatment for aggressive meningiomas with somatostatin receptors.

"This approach is novel and could be a game changer for patients who have grade 2 or grade 3 meningiomas."

— Alyx B. Porter, M.D.

Mayo Clinic also is investigating the use of lutetium 177 (Lu 177) DOTATATE to treat inoperable, progressive meningiomas. Lu 177 DOTATATE delivers radioactive Lu 177 to tumor cells that express somatostatin receptors.

"This approach is novel and could be a game changer for patients who have grade 2 or grade 3 meningiomas," Dr. Porter says. "We're already seeing 50% of patients with progression-free survival in the first six months of this treatment." 68-Ga-DOTATATE PET imaging plays a key role in selecting candidates for this therapy.

Other work aims to better characterize the tumors' heterogenous underpinnings. Led by Dr. Zadeh, researchers have developed a tool to prospectively classify meningiomas into molecular groups. As described in Neuro-Oncology, the tool relies solely on DNA methylation information.

"Previous models have combined multiple genomic approaches that don't lend themselves easily to classifying cases in the clinical setting," Dr. Zadeh says. "This novel point-and-click tool — which we have made publicly available — can be readily integrated into existing DNA methylation-based workflows, to increase personalization of patient care."

Mayo Clinic has long been committed to translating research into patient care. "Our goal is always to give patients the highest possible quality of life," Dr. Clark says. "We achieve that by working closely as a team to apply technical excellence and very safe care."