Dr. Jorge Torales
Neurosurgeon · Skull base and spinal endoscopy
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Extra-axial tumour
Meningiomas: surgery and treatment
Meningiomas are the most common primary brain tumours in adults and are generally benign. Complete resection surgery to Simpson grade I-II offers cure rates above 90% for grade I meningiomas.
What is it?
Meningiomas: surgery and treatment
Meningiomas are tumours that arise from the arachnoid cells of the meninges (the membranes covering the brain and spinal cord). They account for 38% of primary brain tumours and are generally benign (WHO grade I in 80% of cases). Surgery is the treatment of choice when they are symptomatic, and Simpson grade I-II resection is associated with recurrence rates below 10% at 10 years.
38%
of primary brain tumours
80%
are grade I (benign)
<10%
recurrence with Simpson I-II
Symptoms
When to consult a neurosurgeon?
Many meningiomas are asymptomatic and discovered incidentally on imaging. When symptoms occur they typically include:
- Progressive chronic headache, typically worse in the morning
- Focal or generalised epileptic seizures
- Progressive focal motor or sensory deficit depending on location
- Loss of smell in olfactory groove meningiomas
- Visual disturbance (loss of acuity or visual field) in sphenoid wing meningiomas
- Cognitive changes or personality changes
Urgent attention: A meningioma with rapid growth, significant oedema or progressive neurological symptoms requires urgent neurosurgical assessment.
Treatments
What techniques do we use?
Microsurgical resection Simpson I-II
The technique of choice. Includes the tumour, the involved dura and 1 cm of adjacent bone. 4K/3D microscopy to preserve vessels and cranial nerves.
Skull base approach
For sphenoid wing, clinoidal, petroclival or tentorial meningiomas. Pterional, orbitozygomatic, retrosigmoid or transpetrosal approaches depending on location.
Skull base endoscopy
Well-established minimally invasive technique for meningiomas of the anterior cranial fossa and the clivus. Access via a transsphenoidal route (through the nose), with no brain retraction, no external scar and shorter recovery times.
Preoperative embolisation
In highly vascular meningiomas (especially convexity or falcine). Reduces intraoperative bleeding.
Stereotactic radiosurgery
Gamma Knife or CyberKnife for residual tumour, recurrences or patients who are not surgical candidates. Effective for lesions under 3 cm.
Wait-and-scan
For small asymptomatic meningiomas in older patients. MRI monitoring every 6-12 months initially.
Our protocol
How we approach each case
Every patient with a meningioma is assessed with contrast-enhanced MRI and MR angiography when vascular involvement is suspected. In highly vascular meningiomas, diagnostic angiography and embolisation 24-48 hours before surgery are considered. We plan the approach using 3D preoperative modelling for complex locations. Surgery is performed with neurophysiological monitoring for meningiomas affecting cranial nerves or eloquent areas. Follow-up includes MRI at 3 months, 1 year and then annually for 5 years.
Perioperative protocol
How we organise each case
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1 · Preoperative work-up
Brain MRI with gadolinium plus MR angiography to assess blood supply. Preoperative embolisation for hypervascular tumours. Ophthalmological and audiological assessment where the location requires it.
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2 · Surgery
Approach planned according to location (convexity, skull base, parasagittal). Intraoperative neurophysiological monitoring. Microsurgery with a Simpson grade I-II resection target.
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3 · Immediate postoperative period
ICU for 24 hours in most cases. Postoperative MRI within 72 hours. Histopathology with WHO grading determines the follow-up schedule.
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4 · Discharge and follow-up
Discharge between 3 and 6 days depending on location. MRI at 3 months and annually for WHO grade I meningiomas. Complementary radiosurgery if resection is incomplete or grade II-III.
Team
Neurosurgeons who treat this condition
Dr. Abel Ferrés Pijoan
Neurosurgeon · Spine, neuro-oncology and skull base
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Dr. Pedro Roldán Ramos
Neurosurgeon · Spine, functional and brain
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Results
Prognosis and recovery
Complete Simpson grade I-II resection of grade I meningiomas is associated with cure rates above 90% at 10 years. Surgical mortality for convexity meningiomas is below 1% at high-volume centres. Atypical meningiomas (grade II) carry a higher recurrence risk (30-40% at 5 years) and usually require adjuvant radiotherapy. Typical recovery allows discharge in 3-5 days and a gradual return to normal activities in 6-8 weeks.
Frequently asked questions
Answers to your questions
Is a meningioma cancerous?
The majority of meningiomas (80%) are WHO grade I, i.e. benign. Around 18% are atypical (grade II) with a greater tendency to recur, and only 2% are anaplastic (grade III) with malignant behaviour. Biopsy after surgery determines the exact grade.
Do all meningiomas require surgery?
No. Many small, asymptomatic meningiomas are managed with periodic MRI scanning (wait-and-scan), particularly in older patients. Surgery is indicated when they cause neurological symptoms, are growing progressively or are large in younger patients.
What does "Simpson I-II" mean?
It is a surgical classification indicating the extent of resection. Simpson I: complete removal of the tumour, adjacent dura and bone; Simpson II: complete tumour removal with coagulation of the dural insertion. The lower the Simpson number, the lower the probability of recurrence.
What are the risks of meningioma surgery?
The main risks are infection (less than 3%), postoperative haematoma (1-2%), transient neurological deficit (depending on location) and epileptic seizures (10-15% of patients will develop them at some point, requiring perioperative preventive medication).
Is meningioma hereditary?
Most are sporadic. Only a minority are associated with hereditary syndromes such as neurofibromatosis type 2 (NF2), in which patients develop multiple meningiomas alongside vestibular schwannomas. Genetic testing is considered in cases of multiple tumours or onset under 40 years of age.
How long does recovery take after surgery?
Hospital stay is 3-5 days after uncomplicated surgery. Return to work occurs between 4 and 8 weeks in most cases. Contact sports are avoided for 3 months. MRI follow-up takes place at 3 months, 1 year and then annually.
What is stereotactic radiosurgery and when is it used?
Stereotactic radiosurgery (Gamma Knife, CyberKnife) delivers focused radiation in a single session to control small tumours. It is used for meningiomas under 3 cm that are not surgical candidates, for residual tumour after incomplete resection or for recurrences. It does not replace surgery as the primary option when surgery is feasible.
References
What the clinical guidelines say
"The extent of surgical resection, assessed according to the Simpson classification, remains the most important predictor of recurrence in meningiomas."
"The surgical indication for asymptomatic meningiomas must be individualised according to age, location, growth rate and surgical risk."
Bibliography
Scientific references consulted
Studies and clinical guidelines underpinning our approach to this condition.
- Goldbrunner R. et al. EANO guideline on the diagnosis and management of meningiomas. Neuro-Oncology. 2021. View publication
- Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry. 1957. View publication
- Louis DN. et al. The 2021 WHO Classification of Tumors of the Central Nervous System. Neuro-Oncology. 2021. View publication
- Rogers L. et al. Meningiomas: knowledge base, treatment outcomes, and uncertainties (RANO review). J Neurosurg. 2015. View publication
- Kondziolka D. et al. Long-term outcomes after meningioma radiosurgery. Neurosurgery. 2008. View publication
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What our patients say
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"I arrived with a glioma I had been told was inoperable. Here they reviewed it at the tumour board and offered me a plan. The surgery was a success. Four years on, I am well."
Cervical disc herniation
"For years I had a cervical disc herniation, operated on by another team with no improvement. Minimally invasive surgery gave me back my mobility and took the pain away."
International patient
"I travelled from outside Spain. The team reviewed my case before I came and gave me a clear plan. Caring people and impeccable technique."
Request information
Second opinion on your meningioma
Send us your MRI scan. We review the case at our committee and advise whether surgery is the best option or whether observation is appropriate.