Intracranial meningiomas mimicking gliomas: A systematic review of clinical, radiological, and histopathological characteristics
TL;DR
Although they are frequently misdiagnosed before surgery, most of these lesions are low-grade meningiomas, which tend to have good postoperative results, and being aware of these unusual presentations can help improve diagnosis and support better surgical planning.
Abstract
Background: Intracranial meningiomas usually appear as extra-axial tumors with distinctive radiological features that aid in diagnosis. However, a rare subset shows atypical imaging traits and can closely resemble gliomas, leading to diagnostic challenges and impacting surgical decisions and treatment. This review aimed to systematically analyze the literature on intracranial meningiomas that present like gliomas and to summarize their clinical, radiological, pathological, and outcome features. Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. Searches were conducted in PubMed, Scopus, Web of Science, and Google Scholar from inception to June 2026. The review included studies on intracranial meningiomas that were suspected to be gliomas based on radiological, clinical, or intraoperative assessments. Data on patient demographics, clinical presentation, imaging features, pathology results, treatments, and outcomes were collected and summarized descriptively. Results: A total of 17 studies involving 28 patients met the inclusion criteria. The median age was 47 years, with a range from 4 to 74 years, and 64.3% of the patients were male. Preoperative suspicion of glioma was noted in 85.7% of cases, with 42.9% specifically suspected of being high-grade gliomas. Most lesions appeared intra-axial (75.0%), were located intraparenchymally (96.4%), lacked dural attachment (89.3%), and showed peritumoral edema (67.9%). Cystic changes occurred in 46.4% of patients. Histopathology mainly identified World Health Organization Grade I meningiomas (78.6%), despite imaging suggesting a more aggressive nature. Gross total resection was achieved in 78.6% of patients and was generally associated with favorable outcomes. Recurrence and death were each reported in one patient (3.6%). Conclusion: Intracranial meningiomas that resemble gliomas are uncommon lesions often showing atypical radiological features such as an intra-axial appearance, lack of dural attachment, significant peritumoral edema, and cystic changes. Although they are frequently misdiagnosed before surgery, most of these lesions are low-grade meningiomas, which tend to have good postoperative results. Being aware of these unusual presentations can help improve diagnosis and support better surgical planning.