Review Article Skull base meningiomas: is there a place for microsurgery?

Over the last 20 years, management strategies for patients with skull base meningiomas have undergone significant evaluation and change. Initially, basal tumor resection, often with high rates of morbidity and mortality and often only with partial resection, advanced to resection with or without postoperative irradiation. With the wider use of postoperative irradiation in the 1980’s, the progression free five year survival of selected, subtotally resected meningiomas could be increased to approximately 90%. Post resection stereotactic radiosurgery then was performed for small volume residual und recurrent tumors. Observation with serial imaging studies remains an important approach for selected patients, particularly those who are elderly, infirm, or are asymptomatic. Today, not only survival but deficit free survival is demanded by both the neurosurgeon and the patient. With these goals, came the next paradigm shift: primary stereotactic radiosurgery (SR). Our experience showed that stereotactic radiosurgery was a valid approach for many patients with basal meningiomas and could provide results similar or superior to resective surgery [6, 11, 4, 16]. Today’s neurosurgeon must consider the options of both: resection and stereotactic radiosurgery. The minimally invasive nature of radiosurgery and its