Meningiomas: criteria for modern surgical indications

Abstract

The contemporary management of meningiomas is the result of the continuous evolution of neurosurgical techniques, along with the refinement of dedicated instrumentations. Above all, it is the magnification of the surgical view, thanks to the microscope and the endoscope, and their advancements, which allowed the improvement of surgical outcomes, in terms of both extent of resection and morbidity rates. Because of the benign nature of the vast majority of meningiomas, complete tumor resection is curative, and it is the gold-standard treatment. However, in the case of high risk of surgical morbidity, a less aggressive surgical treatment may be justified, also upon tailored analysis of the meningiomas’ biological behavior and the improvements in postoperative strategies. The endoscopic technique plays a role, as a unique visualization tool or in combination with the microscope, in granting so-called maximum allowed resection. Considering the above, the most challenging task confronting modern meningioma surgery remains the selection of the most appropriate surgical approach, the latter greatly depending on location, anatomic tumor features, and relationships with critical neurovascular structures. Herein, we present a cogent analysis of the modern multifaceted indications for the endoscopic treatment of meningiomas, with a glimpse into the adjacent fields.

A Case of Suprasellar, Intrasellar, and Infrasellar Meningioma Presenting as a Visual Field Defect in an Obese Female

“…A diaphragm sellae meningioma must be distinguished from a pituitary macroadenoma because they require various surgical methods. Most intrasellar and suprasellar macroadenomas can be reached by the transsphenoidal approach according to Cappabianca et al, but diaphragm sellae meningiomas may necessitate a craniotomy [ 12 ]. The transsphenoidal approach, on the other hand, is recommended or should be tried first for all subdiaphragmatic meningiomas, regardless of whether the lesion is pituitary adenoma or meningioma, even if it has a minor suprasellar extension [ 11 ].…”

Subtemporal Transcollateral Sulcus Approach for Temporal Horn Tumors: 2-Dimensional Operative Video and Description of the Technique

“…Observational management for incidental asymptomatic meningiomas has been validated by the literature. 17 Although surgery indications for meningiomas are reasonably standardized, these indications are mainly defined by experience-based practice and the nature of the disease, patients' characteristics, radiological appearance and growth interval, and symptomatology. 17 The rationale of the procedure for this case was the evidence of an increase in tumor size, the mass effect on the hippocampus within a 2-year interval and the development of a new onset of memory deficits in a young woman without comorbidities.…”

Meningioma: not always a benign tumor. A review of advances in the treatment of meningiomas

“…The visualization of tumor–vessel relationships has been enhanced with novel imaging techniques such as infrared technology, with the administration of intraoperative indocyanine green videoangiography [ 84 , 85 ]. High-definition exoscope systems are also notable among the technological advancements in neurosurgery.…”