Background: Benign adult brain tumors can be managed conservatively or using surgery, radiation, or medicines. While randomized comparisons assessing tumor recurrence, quality of life, or survival are the ideal means of comparing treatments, it can be difficult to recruit patients to such trials and lengthy follow-up periods are needed because of the slowly progressive natural history of these tumors.
Methods: Review of the literature on benign adult brain tumors using evidence-based standards and focusing on meningiomas, pituitary adenomas, and vestibular schwannomas, which together represent the majority of WHO grade 1 adult brain tumors.
Results: Nearly all studies of benign adult brain tumors were of relatively poor quality (level 3 or poorer). These studies enable grade C recommendations. The safety of meningioma surgery in the elderly varies with institution, radiosurgery is a reliable alternative to surgery in small to medium-sized meningiomas, and the efficacy of drugs in therapy of meningiomas recurring after surgery is difficult to interpret due to a lack of uniform criteria in the studies. Radiosurgery is effective in nonfunctional pituitary adenomas recurring after surgery, while phototherapy is a newer treatment modality with potential benefits in pituitary adenomas that fail surgery or radiation. Vestibular schwannomas can be conservatively managed, but there are no reliable predictors of growth, so serial imaging is important. Radiosurgery has proven to be a reliable alternative to surgery for small to medium-sized vestibular schwannomas, but followup has been relatively short in most studies to date.
Conclusions: While randomized clinical trials comparing conservative management, surgery, radiation, and medical management of benign adult benign tumors are unlikely to occur, there is some level 3 evidence that can assist in their treatment.