There are a number of approaches to meningioma surgery for tumors growing on the meninges of the brain. What to expect depends on the type of surgery; in extreme cases, patients may need to be placed under general anesthesia for a procedure where the skull is opened, while other patients may be able to remain awake and alert through the procedure. Patients should discuss the available options with their surgeons before proceeding with the best option for the situation.
Meningiomas are tumors that develop on the material surrounding the brain, rather than in the brain itself. They tend to have clearly defined margins, making them easier and safer to remove, but they can also appear in hard to reach areas like the skull base. Before meningioma surgery can take place, a series of imaging studies will be performed to learn more about the tumor and its location, in order to determine if it is operable.
The most minimally invasive approach is gamma knife surgery, where targeted radiation is directed at the patient's brain to kill the tumor cells. For this type of meningioma surgery, the patient's head will be screwed into a metal frame, creating four small cuts around the skull. The patient is awake while the gamma knife is used to direct radiation at the right area of the skull. A follow-up scan will be used to confirm that the tumor is gone. Risks can include swelling, potentially leading to the need for medical intervention to relieve pressure inside the skull.
Other minimally invasive approaches to meningioma surgery can include endoscopic surgery through the nose to access the tumor. Patients will be placed under anesthesia for comfort and safety, and risks are slightly higher than with gamma knife surgery, since the patient can develop infections in addition to swelling inside the skull. For tumors in difficult spots like the skull base, more invasive incisions may be needed to reach the tumor, and the patient's risks can increase as well.
If a surgeon can successfully remove the whole tumor in meningioma surgery, the patient may achieve an excellent outcome, with surgery being curative in around 85% of cases. If the entire tumor cannot be removed, the patient may need additional therapy such as radiation to destroy it, and there is a risk of recurrence. Partial removal of tumors deemed incurable can still be beneficial, as it may extend the patient's life and improve quality of life.