Management: Basic Principles

  1. As indicated in the preceding “Natural History” Section, not all meningiomas require any treatment, either in the form of surgery or radiation, at the time of initial diagnosis/presentation.  In my personal practice while at the Cleveland Clinic, among over 200 new patients with meningiomas evaluated each year, about 100 patients were treated with surgery, 10 patients with radiation (or radiosurgery) and 100 patients were observed.
  2. Treatment offered (either surgery or radiation) must guarantee an outcome that is far superior over the natural history (i.e. untreated) itself.
  3. Treatment benefits must far outweigh the risks.
  4. There are only two treatment benefits in meningioma management:
    1. Significant alteration of the natural history of the disease (“prolonging life”)
    2. Reversal or improvement of the presenting neurological symptoms/deficits (“improving life quality”)
  5. There are 3 categories of management options:
    1. Observation
    2. Surgery
    3. Radiation/Radiosurgery

Additional reading:

Lee JH & Sade B:  Management Options and Surgical Principles – An Overview (JH Lee, ed), pp. 203-207), Springer, London, 2008

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