A 60-year-old man has an intracranial meningioma found incidentally on MRI (2 cm, asymptomatic, no oedema). Which management is MOST appropriate based on current evidence?
- A Immediate surgical resection to prevent future growth
- B Stereotactic radiosurgery (Gamma Knife) immediately
- C Active surveillance with MRI at 3, 6, and 12 months, then annually if stable ✓
- D Lumbar puncture to assess CSF pressure before any decision
Correct answer: C. Active surveillance with MRI at 3, 6, and 12 months, then annually if stable
Explanation
Incidental small asymptomatic meningiomas (especially in older patients) are increasingly managed with active surveillance — the majority show no or minimal growth over years of follow-up. MRI surveillance at 3-6 months initially, then annually if stable, is standard. Surgery or stereotactic radiosurgery is offered for growing tumours, larger lesions, symptomatic ones, or those causing oedema. Many small meningiomas never require intervention. This conservative approach avoids unnecessary surgical morbidity.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.