How should I manage a patient with a known meningioma who presents with new neurological deficits?

Management of a patient with a known meningioma presenting with new neurological deficits:

• Arrange an urgent clinical review including appropriate imaging, preferably a standard structural MRI, to assess for tumour progression, recurrence, or complications such as oedema or mass effect. MRI should include T2 weighted, FLAIR, DWI series and T1 pre- and post-contrast volume sequences unless contraindicated.
• Consider advanced MRI techniques (e.g., MR perfusion, diffusion tensor imaging, MR spectroscopy) if standard imaging is inconclusive and early identification of progression is clinically useful.
• Evaluate the extent of neurological deficits and assess neurological function, performance status, and comorbidities to guide further management decisions.
• If imaging shows tumour progression or recurrence, discuss treatment options with the multidisciplinary team, including the possibility of further surgery (if feasible) and/or radiotherapy, taking into account tumour grade, size, location, previous treatments, and patient preferences.
• Consider corticosteroids to manage symptoms related to oedema or mass effect.
• Provide regular clinical review and follow-up imaging tailored to the individual’s tumour characteristics, previous treatments, and life expectancy.
• Refer to neuro-oncology or neurosurgery specialists promptly for multidisciplinary assessment and management planning.

This approach aims to promptly identify causes of new neurological deficits related to meningioma progression or complications and to initiate appropriate interventions to prevent further neurological deterioration and improve outcomes.

References: NICE NG99