American Board of Internal Medicine (ABIM) Certification Practice Exam

Which treatment is considered first-line therapy for large or symptomatic meningiomas?

1. Observation

2. Surgical resection

3. Radiation therapy

4. Arterial embolization

The correct answer is: Surgical resection

Surgical resection is regarded as the first-line therapy for large or symptomatic meningiomas due to the nature of these tumors and their potential impact on surrounding brain structures. Meningiomas, which are often slow-growing tumors that arise from the meninges, may cause significant symptoms depending on their size and location. When these tumors become large or begin to produce symptoms—such as headaches, neurological deficits, or seizures—intervention is typically necessary. Surgical resection is preferred as it not only alleviates symptoms by removing the mass effect exerted by the tumor, but also provides the best opportunity for definitive treatment. In many cases, it can lead to complete tumor removal, which reduces the risk of recurrence compared to non-surgical approaches. While other treatment options, such as observation, radiation therapy, or arterial embolization, may be appropriate in specific scenarios (like in asymptomatic patients or when surgery poses too great a risk), they do not serve as the first-line treatment for large or symptomatic meningiomas. Observation is generally reserved for small, asymptomatic tumors; radiation therapy is typically used for cases that are unresectable or when surgery is not feasible; and arterial embolization is generally a palliative treatment used to reduce blood supply