Commentary

The authors retrospectively reviewed 26 patients who underwent microsurgical resection of skull base meningiomas over an 11-year period. All tumors were less than 3 cm. Gross total resection was achieved in 65% of patients and subtotal resection was achieved in 35%. The rate of tumor control was excellent (92%). Two patients (7.6%) had transient cerebrospinal fluid leaks and two had mild facial nerve palsies. The latter improved over a 6-month period but their final House-Brackmann grade is unclear. One month after surgery, symptoms improved in 65% of patients. The clinical results, however, cannot be duplicated in radiosurgical patients. Overall, symptoms improved in 88% of patients. During a 56-month follow-up, 92% remained alive. Two patients died from unrelated causes.

Open surgical resection or gamma knife radiosurgery should be considered for patients with skull base meningiomas. Our institution offers surgical resection to patients with accessible tumors that appear to be compressing the brain stem significantly or causing mass effect, and to patients whose tumors can be resected totally with minimal complications. Gross total resection provides patients a 90 to 96% chance of disease-free progression in the near future. Radiosurgery offered as an adjunct or alternative to surgical resection is a viable option for subtotally resected lesions, for patients who are poor surgical candidates, and for patients who do not desire open surgical resection. This contemporary neurosurgical series serves as one of many studies to set the standard for excellent neurosurgical outcomes. Although the complication rate will always be higher in patients who undergo open surgery, patients who undergo radiosurgery for skull base meningiomas will never have magnetic resonance images that are free of tumor.