Towards a hypermodern theory of meningioma surgery

In spite of significant improvements in patient outcomes, meningioma surgery continues to be associated with appreciable morbidity and variability in management schemes, suggesting an opportunity for improvement. In this article, we attempt to cross-pollinate our discipline with theoretical concepts and analytic frameworks from the field of cultural studies over the past several decades. We provide an overview of modernist, postmodernist, and hypermodernist thinking, the last of which emphasizes rapid progress, repeated recreation of dogmas, and data-driven decision-making. We subsequently demonstrate how the evolution of these schools of thought can be used to improve the analytic approach to comparative outcomes research in neurosurgery, with meningioma research as a principal example. We contend that with the renaissance of microsurgery and advent of improved technologies in meningioma management over recent years, modernist analytic methods are no longer adequate. Instead, we advocate for a new hypermodern paradigm that provides evidence-based answers to unresolved questions, minimizes unwarranted variability in clinical practice patterns, and provides a system for continuous assessment and reassessment of outcomes in the rapidly evolving environment of contemporary skull base neurosurgery. In particular, we discuss the relevance of historical case series from leading neurosurgeons for clinical decision-making, the value of seeking new data for longstanding clinical questions, the merits of radiosurgery versus open surgery, and the importance of recognizing tumor heterogeneity rather than simply stratifying them based on general characteristics such as tumor location. In turn, we lay a conceptual foundation for improving outcomes research in meningioma surgery.