Meningiomas of different locations require varying surgical approaches that are primarily dictated by anatomical considerations inherent to each particular location. Surgical procedures of many different anatomical regions are discussed in several other chapters in this book. Furthermore, an abundance of excellent descriptions of "standard" techniques and approaches for meningioma surgery is available . This chapter is written not to replace, but to supplement, those previous important writings on the topic. Several key concepts and principles deemed important are reiterated, and new insights and lessons learned by the senior author, based on his personal surgical experience with over 600 meningioma patients, are summarized and presented.
Surgical approaches may vary in meningioma surgery depending on the tumor location and size and the surgeon's personal experience and preference. However, the following basic principles hold for meningioma surgery of most locations:
• Optimal patient positioning, incision and exposure
• Early tumor devascularization
• Internal decompression or extracapsular dissection
• Early localization and preservation of adherent or adjacent neurovasculature
• Removal of involved bone and dura
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