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Neurosurgery for Meningiomas

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Abstract

Meningiomas are the most common primary brain tumor in adults, accounting for 37% of all such masses, with an annual incidence of about 27,000 new cases currently (Ostrom et al. Neuro Oncol 18:v1–v75, 2016). The vast majority of these tumors (>80%) are classified as Grade I tumors, meaning that they do not infiltrate brain tissue or metastasize and are considered “mostly benign” (Perry, and Brat Practical surgical neuropathology: a diagnostic approach. Churchill Livingstone Elsevier, Philadelphia, PA, 2010). However, these tumors can produce a variety of neurologic symptoms, including seizures and focal neurologic signs that relate to the brain regions most proximal to the tumor (Daras, and Kaley Continuum (Minneapolis Minn) 21:397–414, 2015). Cognitive symptoms are not uncommon in this population (Butts et al. J Neuro Oncol 134:125–132, 2017; Meskal et al. J Neuro Oncol 128:195–205, 2016). The decision to resect meningiomas depends on many factors, including tumor location, rate of growth, size, and the patient’s surgical risk factors. Neurologic and/or cognitive symptoms caused by the tumor are important factors in surgical decision-making. It is not uncommon that these symptoms are subtle and difficult to assess in a basic neurosurgical physical examination or mini-mental status exam may not be sensitive to the relevant symptoms (Meyers, and Wefel J Clin Oncol 21:3557–3558, 2003). Neuropsychological evaluation can be a helpful adjunct for neurosurgeons in their preoperative decision-making as well as evaluation postoperatively to determine if resection of the tumor resolved the patient’s symptoms. In this chapter, we present three cases with varying clinical presentations that illustrate the collaborative role of neuropsychology and neurosurgery in the care of these patients.

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Author information

Authors and Affiliations

  1. Massachusetts General Hospital, Boston, Massachusetts, USA

    Michael W. Parsons

  2. Cleveland Clinic, Cleveland, Ohio, USA

    Paramita Das & Pablo Recinos

Authors
  1. Michael W. Parsons
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  2. Paramita Das
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  3. Pablo Recinos
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Corresponding author

Correspondence to Michael W. Parsons .

Editor information

Editors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA

    Karen M. Sanders

Chapter Review Questions

Chapter Review Questions

  1. 1.

    In addition to assessing cognition, neuropsychological evaluations also provide important information on which other factor(s) in patient outcome from meningioma surgery:

    1. A.

      Emotion, personality, and behavior change symptoms related to tumor.

    2. B.

      Psychosocial issues such as support available and caregiver burden that may play a role in the outcome.

    3. C.

      Insight into cognitive deficits.

    4. D.

      All of the above.

  2. 2.

    Grade II and III meningiomas:

    1. A.

      Are more common than benign meningiomas and less likely to induce cognitive symptoms.

    2. B.

      Are less common than benign meningiomas and more likely to induce cognitive symptoms.

    3. C.

      Require surgery as the cornerstone of treatment.

    4. D.

      B and C.

  3. 3.

    Useful criteria for deciding which meningioma patients may benefit from neuropsychological evaluation include all of the following, except:

    1. A.

      History of head injury.

    2. B.

      Family report of cognitive symptoms.

    3. C.

      Patient complaint of cognitive symptoms.

    4. D.

      Tumor location.

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Parsons, M.W., Das, P., Recinos, P. (2019). Neurosurgery for Meningiomas. In: Sanders, K. (eds) Physician's Field Guide to Neuropsychology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-8722-1_21

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  • DOI: https://doi.org/10.1007/978-1-4939-8722-1_21

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-8720-7

  • Online ISBN: 978-1-4939-8722-1

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