Meningioma: Viewpoint—Surgery

Abstract

Meningiomas are benign tumors (WHO grade 1) derived from arachnoid cap cells and found attached to dural surfaces outside the brain. More aggressive forms (Grade II and III) may be histologically invasive and aggressive and tend to recur despite treatment. Meningiomas are often found incidentally but may present with headaches, seizure, or focal neurological deficit depending on their location. There is a female predominance and a link to previous radiation therapy. On imaging, they appear as homogenously enhancing lesions distinct from the brain, but may cause significant mass effect and edema and often are associated with a dural “tail.” Surgical treatment can cure the patient provided a complete resection including dural attachments and bone invasion are removed as well. If a complete surgical resection is not accomplished, radiosurgery can be used to treat residual disease. Grade II and III meningiomas have a higher risk for recurrence and should always be treated with postoperative radiation therapy or radiosurgery when there is residual disease and even when there is a complete resection. Specific strategies for different locations in the brain are given in this chapter.