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Management of Meningiomas

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To the Introduction and Contents of Management of Cranial and Spinal Meningiomas

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Congress of Neurological Surgeons Honored Guest Presentation
Originally Published Clinical Neurosurgery, Volume 40, Chapter 17, Pages 321-383, 1992
Used with permission of the Congress of Neurological Surgeons.
HTML Editor: Stephen B. Tatter, M.D., Ph.D.
Disclaimer: The information and reference materials contained herein are intended solely to provide background information. They were written for an audience of physicians. They are in no way intended to constitute medical advise. For medical advise a physician must, of course, be consulted.


CT Scan of Meningioma
FIG. 17.9. Middle fossa meningioma. This 47-year-old woman presented with a seizure. Removal was followed by total recovery. (A and B) CT axial images (A and B) after contrast show the tumor projecting into the left temporal lobe from the floor and lateral wall of the middle fossa, with associated hyperostosis.


(Meningioma Management, File 9)


Meningiomas in the middle fossa may arise from the region of the cavernous sinus, from the posterior aspect of the sphenoid wing or the floor of the middle fossa, or from growth which extends into the area from the clivus, petrous bone, or sphenoid wing. The cavernous sinus meningiomas will be considered in the next section.

MRI or CT usually provides all the information the surgeon needs (FIG. 17.9). Angiography is not needed in smaller tumors but may be necessary in larger tumors to define the relationship to the internal carotid artery and to evaluate the blood supply. Embolization has not been needed. The indications for surgery are neurological symptoms in younger patients with any size tumor and in older patients with large tumors. Radiation therapy is used when there is regrowth following radical subtotal removal. Observation is recommended in older patients when the tumor is small.

The key considerations of the operation are the same as outlined under "General Considerations in Management" (see above). For anteriorly placed lesions a question mark incision is made. For more posterior tumors a horseshoe-shaped incision is made.
TABLE 17.7 Middle Fossa Meningiomas
aRemoval bOutcome Complications Recurrence
T 7 Good 10 None None
RST 3 Fair 1 (1)
ST 2 Poor 1 (1)
aT, total removal
RST, radical subtotal removal
ST, subtotal removal
bGood, free of major neurological deficit
and able to return to previous activity level
Fair, independent but not able to return to full activity
because of new neurological deficit or significant
preoperative deficit that did not fully recover
Poor, dependent.


There were 12 patients, eight women and four men, ranging in age from 43 to 78 years, with four over 70 years of age (Table 17.7). In all patients the tumor compressed the temporal lobe. Seven had a total removal, three a radical subtotal removal, and two a subtotal removal because of age and/or growth into the cavernous sinus. There were no major complications and all were helped by the operation. Ten had a good result. One was judged to be in the fair category and one in the poor category because serious preoperative disabilities did not recover.

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