Current RMA Instruments
| 64 of 2026 | |
| 65 of 2026 |
Changes from previous Instruments
ICD Coding
- ICD-10-AM Codes: D32.0, D32.9
Brief description
A cerebral meningioma is a tumour arising from the meninges, which are the membranes covering the brain. Most meningiomas are slow-growing and non-cancerous and may cause no symptoms, particularly when small.
For the purposes of the SoP, cerebral meningioma includes grade 1 (benign or typical) and grade 2 (intermediate or atypical) tumours. Grade 3 meningiomas are malignant and are not covered by this SoP.
Symptoms, when present, depend on the size and location of the tumour and may include headaches, seizures, weakness, changes in sensation, or problems with vision, speech or other neurological functions.
Confirming the diagnosis
Cerebral meningioma is usually identified on brain imaging, particularly MRI or CT. Meningiomas often have characteristic imaging features that allow a clinical diagnosis to be made without obtaining a tissue sample, particularly where the tumour is being managed with observation rather than surgery.
Where surgery or biopsy is performed, histological examination confirms the diagnosis and determines the tumour grade. The distinction between grade 1, grade 2 and grade 3 disease is important because grade 3 malignant meningioma is excluded from this SoP.
A neurosurgical assessment is required for confirmation of this diagnosis. A neurologist, radiation oncologist or other appropriate specialist may also be involved depending on the presentation and management.
Additional diagnoses covered by SOP
- Atypical meningioma (grade 2)
- Benign meningioma (grade 1)
- Intermediate grade meningioma (grade 2)
- Typical meningioma (grade 1)
Conditions excluded from SOP
- Anaplastic meningioma (grade 3) *
- Malignant meningioma (grade 3) *
- Malignant neoplasm of the cerebral meninges *
- Meningioma arising from the spinal meninges #
* another SOP applies
# non-SOP condition
Clinical onset
Cerebral meningiomas are often slow-growing and may be present for a considerable period before they are detected. Some are discovered incidentally on brain imaging performed for an unrelated reason.
Where the meningioma is symptomatic, clinical onset will generally be based on the earliest symptoms or signs that can reasonably be attributed to the tumour. These will depend on its location and may include seizures, headaches or focal neurological symptoms such as weakness, sensory changes, or visual or speech disturbance.
Where a meningioma is asymptomatic and discovered incidentally, there may be no earlier symptomatic clinical onset. In these cases, the first objective evidence of the tumour on imaging will generally establish when the condition can first be identified.
Clinical worsening
The natural course of cerebral meningioma varies according to factors including tumour size, location, growth rate and grade. Some small grade 1 meningiomas remain stable for long periods and require only observation with periodic imaging, while others enlarge and require treatment. Grade 2 meningiomas generally have a greater risk of growth and recurrence than grade 1 tumours.
When assessing clinical worsening, it is important to consider whether the change represents worsening beyond the expected natural course of the particular tumour. Specialist assessment is required to distinguish true worsening from expected tumour progression or recurrence.