Meningiomas: Contemporary Treatment

Although meningiomas represent only ~15% of intracranial tumors, they have been referred to as “the soul of neurosurgery.” This is because meningiomas, in their diagnosis, imaging, and treatment, parallel the evolution of neurosurgery. Treatment of these usually benign tumors can be one of the most satisfying aspects of neurosurgical practice. Microsurgical removal is enhanced by advanced technology, including microscopes, lasers, endoscopes, and frameless image guidance. The meticulous neurosurgeon is rewarded with long-term patient survivals and even cures. Adjunctive treatment of meningiomas with radiosurgery can allow long-term tumor control in patients whose lesion cannot be surgically resected. On the other hand, the small minority of meningiomas that are malignant continue to defy attempts to eradicate them.

This issue of Seminars in Neurosurgery provides an up-to-date and comprehensive summary of our understanding of this fascinating tumor at the current time.

The contributors to this issue compose an international list of experts in the field. I thank them for their superb contributions, which are both thorough and completely up-to-date.

This issue begins with a thoughtful review of the history of meningiomas presented by Drs. Wang, Lanzino, and Laws. Drs. Ragel and Jensen, as well as Drs. Ware, Quinones-Hinojosa, and McDermott, have provided excellent offerings on pathophysiology that will help neurosurgeons answer with some degree of scientific precision the commonly asked patient question: “How did I get this tumor?” Dr. Raksin's article completes the pre-operative discussion by detailing appropriate imaging of such lesions.

The next section describes surgical management of these tumors. Region by region, details of technique are discussed by experts in the field. Drs. Hancq, Baleriaux, and Brotchi present the evolution of their experience with parasagittal meningiomas. Drs. Jane, Dumont, Vance, and Laws describe the evolution of their transsphenoidal transtuberculum approach for suprasellar meningiomas. Drs. Vecil and McCutcheon, Margalit and Sen, and D'Ambrosio et al carefully detail their surgical technique for meningioma resection in the convexity, foramen magnum, and lateral ventricles, respectively. Dr. White describes surgical management of spinal meningiomas. Drs. Mizen and Rosseau present meningiomas of the orbit, optic nerves, and anterior visual pathways.

The next section deals with radiosurgery for treatment of meningiomas. Dr. Friedman presents his experience with the linear accelerator for such tumors, and Dr. Duma et al describe the use of the gamma knife.

Finally, Drs. Rosseau and Cokluk describe the unfortunate tendency of meningiomas to recur, and outline treatment strategies when this happens. Drs. Hentschel and McCutcheon further describe chemotherapy and biological therapy as adjunctive treatment for meningiomas.

It is our hope that this issue of Seminars in Neurosurgery will provide the neurosurgeon with a comprehensive and completely up-to-date summary of this most fascinating subject. I would like to personally acknowledge and thank each of the authors for the time they have invested in this publication. I believe this to be an outstanding contribution to the literature and hope that this will be of practical value to all who care for patients who have meningiomas.