General Principles

Surgery is the treatment of choice for most patients with meningiomas. In patients with benign meningiomas, which comprise approximately 94% of all meningiomas [24], the tumor location largely dictates the extent of resection, which, in turn, determines the tumor recurrence and, ultimately, the patient's survival [2,19,22,24]. Primary goals of surgery include:

(1) total resection of the tumor and the involved surrounding bone and dura when possible, and

(2) reversal or improvement in neurological deficits/symptoms caused by the tumor. In meningiomas of certain locations, such as the cavernous sinus or petroclival regions where complete resection is not always possible, additional surgical goals may include confirmation of diagnosis and tumor reduction (to less than 3 cm maximum diameter) in preparation for radiosurgery. Given the benign nature of meningiomas and the established efficacy of adjuvant radiation, the goal of total removal must be balanced by the physician's basic credo to "do no harm". When total removal carries a significant risk of morbidity, a small piece of tumor may be left, with further plans of observation followed by re-operation or radiation when the tumor is noted to be growing or causing new symptoms (Fig. 12.1).

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