Growth Estimates

Another method of approximating the "natural history" of meningiomas is to estimate the mean doubling time of tumor volume (Td). Jaaskelainen et al. [16] determined the Td in a series of 43 patients with meningiomas by following them for recurrence after resection. Individual and mean Tds for their patients were determined by measuring tumor volume on serial imaging studies. They found that the Td was 415 days (range 138-1045) for benign meningiomas, 178 days (range 34-551) for atypical meningiomas, and 205 days (range 30-472) for anaplastic meningiomas. However, these average estimates are derived from wideranging values, and significant overlaps exist among the different groups.

By using bromodeoxyuridine (BUdR) labeling and tumor Td determinations, Cho et al. [17] found Tds ranging from 8 to 440 days in eight tumor samples (two benign, four malignant, two hemangiopericytomas). This group also noted a close inverse correlation between the BUdR labeling index and the tumor doubling time. The implications of these findings were that BUdR labeling may supplement histopathological information in estimating prognosis and may be used to calculate the Td before actual recurrence of the tumor. Clearly, such information would be valuable when formulating plans for any additional treatment of residual tumor following subtotal resection or recurrent meningiomas after complete resection.

Although the Td and BUdR studies have provided some insight toward the growth rates of meningiomas, in clinical practice they require at least an operative biopsy to determine the histology and the BUdR labeling index. A novel approach from Shino et al. [18] was to correlate the MIB-1 staining index (SI) with proton magnetic resonance spectroscopy (MRS) data. They reported that "a significant linear correlation

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