Meningioma surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ifeoma Odukwe, M.D. [2] Haytham Allaham, M.D. [3]


The predominant therapy for meningioma is surgical resection, it is preferred in symptomatic patients. Adjunctive radiation therapy may be required among certain patients. The decision to undergo surgery or radiotherapy depends on factors such as age, postoperative morbidity, patient's preference, and more. The Simpson criteria for meningioma, which consists of 4 grades, correlates the degree of surgical resection completeness with the probability of post-surgical tumor recurrence.


  • Surgery is not the first-line treatment option for patients with asymptomatic meningiomas.
  • It is the preferred method for treating symptomatic meningiomas.[1]
  • The decision to undergo surgery is based on age, symptoms, radiological features, postoperative morbidity, and patient preference.[1]


  • Gross total resection including the involved dura is the standard surgical treatment of a meningioma.[2]
  • The surgery is successful if the tumor is completely removed. This is considered curative.[3]
  • When treating meningiomas, the prediction of possible recurrence and survival for malignant or transient types of meningiomas are the most important prognostic factors.[4]
  • As an alternative to surgery, stereotactic radiosurgery can be used either as a first line treatment or at recurrence.[3]
  • In situations where complete resection (with low morbidity) can be achieved, and/or to decompress tumors associated with pressure symptoms, surgery is highly appropriate.[5]
  • Radiotherapy is an option that can be used in the treatment of meningioma but, surgery is usually preferred. This is based on symptoms, age, radiological features, postoperative morbidity, patient preference and when a definite diagnosis is necessary.[1]
  • Preoperative embolization of a meningioma may be done to help in reducing blood loss and surgical time during meningioma resection. This can cause some changes in the histology of the tumor which may lead to over grading of the tumor by the pathologist. The histological changes include macronucleoli, necrosis, and compensatory proliferation with increased numbers of mitotic figures.[6][7]
  • Microsurgical resection may be done for posterior fossa meningiomas.[8]
  • Modern image-guided minimally invasive surgery may be done for cerebral convexity meningiomas.[9]
  • The approach taken to resect a meningioma may be done based on the location of the tumor:[8]
  • The Simpson criteria for meningioma correlates the degree of surgical resection completeness with the probability of post-surgical tumor recurrence:[10]
Simpson Grade Completeness of Resection 10-Year Recurrence
Grade 1
Complete tumor resection including removal of dural attachments and abnormal bone


Grade 2
Complete tumor resection and coagulation of dural attachments


Grade 3
Complete tumor resection without resection or coagulation of dural attachments or extradural extensions (e.g invaded or hyperostotic bone)


Grade 4
Subtotal resection (partial tumor resection)



  1. 1.0 1.1 1.2 Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF; et al. (2018). "Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy". Asian J Neurosurg. 13 (1): 86–89. doi:10.4103/1793-5482.181115. PMC 5820904. PMID 29492130.
  2. Goldbrunner R, Minniti G, Preusser M, Jenkinson MD, Sallabanda K, Houdart E; et al. (2016). "EANO guidelines for the diagnosis and treatment of meningiomas". Lancet Oncol. 17 (9): e383–91. doi:10.1016/S1470-2045(16)30321-7. PMID 27599143.
  3. 3.0 3.1 Alexiou GA, Gogou P, Markoula S, Kyritsis AP (2010). "Management of meningiomas". Clin Neurol Neurosurg. 112 (3): 177–82. doi:10.1016/j.clineuro.2009.12.011. PMID 20056312.
  4. Sumkovski R, Micunovic M, Kocevski I, Ilievski B, Petrov I (2019). "Surgical Treatment of Meningiomas - Outcome Associated With Type of Resection, Recurrence, Karnofsky Performance Score, Mitotic Count". Open Access Maced J Med Sci. 7 (1): 56–64. doi:10.3889/oamjms.2018.503. PMC 6352459. PMID 30740161.
  5. Smee R, Williams J, Kotevski D, Schneider M (2019). "Radiotherapy as a means of treating meningiomas". J Clin Neurosci. 61: 210–218. doi:10.1016/j.jocn.2018.10.006. PMID 30782319.
  6. Chen L, Li DH, Lu YH, Hao B, Cao YQ (2019). "Preoperative embolization versus direct surgery of meningiomas: A meta-analysis". World Neurosurg. doi:10.1016/j.wneu.2019.02.223. PMID 30954743.
  7. Commins, Deborah L.; Atkinson, Roscoe D.; Burnett, Margaret E. (2007). "Review of meningioma histopathology". Neurosurgical Focus. 23 (4): E3. doi:10.3171/FOC-07/10/E3. ISSN 1092-0684.
  8. 8.0 8.1 Velho V, Agarwal V, Mally R, Palande DA (2012). "Posterior fossa meningioma "our experience" in 64 cases". Asian J Neurosurg. 7 (3): 116–24. doi:10.4103/1793-5482.103710. PMC 3532757. PMID 23293666.
  9. Morokoff AP, Zauberman J, Black PM (2008). "Surgery for convexity meningiomas". Neurosurgery. 63 (3): 427–33, discussion 433-4. doi:10.1227/01.NEU.0000310692.80289.28. PMID 18812953.
  10. Rogers L, Barani I, Chamberlain M, Kaley TJ, McDermott M, Raizer J; et al. (2015). "Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review". J Neurosurg. 122 (1): 4–23. doi:10.3171/2014.7.JNS131644. PMC 5062955. PMID 25343186.

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