[Operability of intracranial meningiomas]

Intracranial meningiomas are lesions which generally can be removed radically by surgery. However, because of their location, the extension of the dural attachment, the inclusion of the main arteries of the circle of Willis or of cranial nerves, total removal carries a high risk of morbidity. In a review of a personal series of 500 cases, the limits of surgery are discussed and different groups of tumors are defined corresponding to their surgical operability. Although surgery appears indisputable on the convexity of the brain, para-sagittal and anterior basal meningiomas, total removal remains questionable for tumors of the inner part of the sphenoid ridge, of the petrous bone and of the falco-tentorial junction. In a few other cases, surgery is either unnecessary (asymptomatic meningioma) or inefficient in that there is no clear benefit for the patient (cavernous sinus meningioma). In the cases where surgery does not offer a complete cure, radiotherapy may be considered.