The surgical procedures performed on patients with meningioma vary depending on the size and location of the tumor, and are best performed by highly skilled neurosurgeons with experience in treating brain tumors.
Surgical biopsy: The first surgery a patient may have is a biopsy, to extract a sample of the tissue to determine what it is. In many cases, the sample is biopsied quickly while the patient is on the operating table so that the resection (removal) surgery can be done at the same time.
Resection (removal): A highly skilled neurosurgeon will remove as much of the tumor as possible without damaging healthy brain tissue. The skill and training of the neurosurgeon is critical to how much of the tumor can be removed, and how invasive the surgery is. For example, if the tumor is located in the skull base a minimally invasive “endonasal endoscopic” approach may be used to remove the meningioma through the nose (see more about Skull Base Surgery). Traditional surgery may be necessary if the meningioma is out of reach of endoscopic techniques or has invaded nearby brain structures.
Pre-operative embolization is sometimes recommended to make the resection surgery easier and less risky. An embolization specialist will thread a catheter through a blood vessel from the leg to the site of the tumor, then deliver a gluey material through the catheter to the tumor site to cut off its blood supply. Embolization is an advanced technique in a fast-changing specialty, and it’s best performed by interventional radiologists at major medical centers (see Doctors Who Treat Meningioma).
Stereotactic radiosurgery uses highly focused beams of radiation to attack a tumor from multiple angles. Stereotactic radiosurgery, often called CyberKnife, Gamma Knife, or LINAC (linear accelerator), may be used alone or in combination with open surgery. (See more about the Stereotactic Radiosurgery Program.)
Awake surgery and brain mapping
Sometimes, your neurosurgeon will need to map your brain during your procedure. This may entail you being awake for part of the procedure. Don’t worry – it will not be painful. The awake portion of the procedure is designed so that your surgeon can localize the areas of your brain critical for language function or movement. This allows your surgeon to remove the maximal amount of tumor while keeping you safe in the process. (See I Was Awake During My Brain Surgery for a patient’s view of what an awake craniotomy is like.)
In many brain tumor operations, patients can now benefit from intraoperative fluorescence using 5-ALA technology. Using this novel treatment, surgeons have a new way of visualizing brain tumors separately from healthy brain tissue, thereby maximizing the degree of brain tumor removal.
At Weill Cornell Brain and Spine Center, our neurosurgeons are highly skilled in the most advanced procedures for treating meningiomas and other brain tumors. Use our online form to request an appointment for an evaluation or second opinion.
Reviewed by: Rohan Ramakrishna, M.D.
Last reviewed/last updated: August 2023