Surgical management of patients with meningiomas is arguably the most rewarding, challenging and, at times, daunting task for a neurosurgeon: rewarding because of the benign nature of most meningiomas, leading to a possibility of providing cure following total removal; challenging because of the tumor's common sites of involvement in proximity to critical neurovascular structures and/or along the skull base, making surgery difficult and highly risky; daunting because of the associated risks of surgery, the tumor's tendency to recur following incomplete (and at times complete) removal, and its frequent involvement of the surrounding skull-base bone, dura and neu-rovasculature, making complete removal often impossible.
The term "meningioma" was introduced by Cushing in 1922 to clarify the hitherto confusing and numerous histopathological nomenclatures used to describe the tumor. These names have included: "fongueuses de la dure-mère" (Louis 1774), "epithelial cancer" (Bennett 1858), "tumeurs fibro-plastiques" (Lebert 1854), "cylindroma" (Billroth 1856), "epithelioma" (Bouchard 1864), "sarkome der dura mater" (Virchow 1863), "endothelioma" (Golgi 1869), "villous arachnoid tumor" (Cleland 1864), "arachnoid fibroblastoma" (Mallory 1920) and "meningeal fibroblastoma" (Penfield 1932). Whereas the previous names were descriptive based on the tumor's varying appearances, or based on its presumed histiogenesis, the new term "meningioma" was used to simply convey the meningeal involvement. The first report of this fascinating tumor dates back to 1614, and it is credited to Felix Plater of Switzerland. Although there are earlier reports of partial or failed removal of meningiomas, W.W. Keen is credited with the first successful surgical resection of a meningioma in the USA, in 1887.
Surgery continues to be the treatment of choice for most patients with meningiomas. Recent advances in neuroimaging, anesthesia, microsurgery, surgical instrumentation,
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