Feasibility of a screening program for the detection of intracranial meningiomas.

Meningioma is a common slow-growing intra-cranial neoplasm affecting 2-3% of the population, with the potential for irreversible brain damage. The widespread availability of modern neuroimaging allows early detection of small asymptomatic meningiomas. Given that morbidity and mortality rates associated to treatment of small asymptomatic meningiomas is remarkably lower than that of symptomatic, it can be hypothesized whether active search for meningiomas in the general population is warranted. In this paper we explore the justifications and rationale of an eventual screening program for the detection of small asymptomatic meningiomas and discuss its feasibility. Cost-effectiveness, applicability, and ethical issues are also analyzed. Screening for meningiomas would secondarily identify other incidental findings (brain aneurysms, pituitary adenomas, and many others) that would also benefit from surveillance and/or treatment. A broad screening protocol, based on magnetic resonance, with specific calculations for a regional area in Spain, is also provided. Meningiomas are prevalent lesions with a prolonged pre-symptomatic period in which early detection is possible. Magnetic resonance is simple, accurate, innocuous, and serves as screening and confirmatory test. Although screening for asymptomatic meningiomas seems to be clinically well-substantiated and no ethical issues a priori preclude its implementation, its cost-effectiveness needs to be further studied and confirmed.