Meningiomas

Meningiomas are benign and slow growing tumors, mostly WHO grade 1. Surgery is the primary treatment for symptomatic or enlarging meningiomas. The strongest predictors of recurrence-free survival are the WHO grading and the extent of resection, but this depends on the anatomical location. Gamma Knife Stereotactic Radiosurgery (GKSRS), in single or multiple sessions, or standard conventional radiation therapy should be recommended if the gross total resection (defined as Simpson 1–3) is not achieved. Radiation therapy is approved as an adjuvant therapy for anaplastic meningioma while considering for atypical tumors after gross total resection. GKSRS could be proposed as a primary treatment in small and critically located meningiomas, even if asymptomatic, to prevent their enlargement and the need of surgery or the development of neurologic symptoms. Combined microsurgery and stereotactic radiosurgery may be used in selected cases, namely large meningiomas located in such critical areas as skull base or next to dural venous sinuses, to decrease the surgery related morbidity, ensuring a good tumor growth control.