Current RMA Instruments
| Reasonable Hypothesis SOP | 1 of 2018 |
| Balance of Probabilities SOP | 2 of 2018 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 225.2
- ICD-10-AM Codes: D32.0, D32.9
Brief description
This SOP covers meningiomas that are benign or intermediate grade and arise in the lining of the brain. It does not cover malignant meningiomas (rare) or meningiomas of the lining of the spinal cord (also rare).
Confirming the diagnosis
The diagnosis may be suspected based on imaging findings (CT or MRI of the brain), but definitive diagnosis requires histology.
The relevant medical specialist is a neurosurgeon.
Additional diagnoses covered by SOP (see also classification, below)
- Atypical meningioma (WHO grade II)
- Benign meningioma (WHO grade I)
- Intermediate grade meningioma (WHO grade II)
Conditions excluded from SOP
- Anaplastic meningioma (WHO grade III)* - malignant neoplasm of the cerebral meninges SOP
- Malignant meningioma (WHO grade III)* - malignant neoplasm of the cerebral meninges SOP
- Meningioma arising in the spinal cord meninges#
* another SOP applies
# non-SOP condition
Clinical onset
The condition tends to be asymptomatic or minimally symptomatic and be found incidentally on imaging (or at autopsy). Clinical features may include seizures and focal defects related to the tumour location.
Clinical worsening
The natural course of a meningioma varies with size and grade. Grade 1 tumours may simply require observation. Treatment for grade two tumours is surgery with or without radiotherapy. Grade two tumours have a high recurrence rate. Evidence of clinical worsening beyond the normal course of the disease is required for a clinical worsening factor to apply.
World Health Organisation 2016 Classification of Meningiomas
WHO Grade 1 (covered by SOP)
- Meningiothelial meningioma
- Fibrous (fibroblastic) meningioma
- Transitional (mixed) meningioma
- Psammomatous meningioma
- Angiomatous meningioma
- Microcystic meningioma
- Secretory meningioma
- Lymphoplasmacyte-rich meningioma
- Metaplastic meningioma
WHO Grade 2 (covered by SOP)
- Chordoid meningioma
- Clear cell meningioma
- Atypical meningioma
WHO Grade 3 (covered by MN cerebral meninges SOP)
- Papillary meningioma
- Rhabdoid meningioma
- Anaplastic meningioma