Intracranial meningiomas – an overview of management strategies

T. Ghica MD1, D.L. Ivan MD1, A. Dabu MD PhD1

Assoc. Prof. D.M. Teleanu MD. PhD1,2

1. Department of Neurosurgery, University Emergency Hospital, Bucharest

2.“Carol Davila” University of Medicine and Pharmacy, Bucharest

Background:
Meningiomas are the most common benign intracranial tumors, originating from meningothelial
cells present in the arachnoid layer of the meninges and are found over the convexities or in the
skull base.
Whereas they predominantly encompass benign features, they still present a challenge regarding
the therapeutic approach. Surgery is the main treatment with the aim to completely remove the
tumor, in selective cases preceded by preoperative endovascular embolisation.
Pre-operative embolisation of intracranial meningioma has been demonstrated to decrease blood
loss and to improve the extent of resection. In cases of recurrence, additional options include ra-
diotherapy and stereotactic radiosurgery.

Materials and Methods:

Retrospective study on a cohort of 89 patients who were diagnosed with intracranial menin-
giomas and underwent surgical treatment in the Neurosurgery I Department of the University
Emergency Hospital Bucharest between 2011 and 2022. A number of 29 patients (32.58%) un-
derwent preoperative angiography and endovascular embolisation. 
Tumor characteristics (type, location, volume, percentage of supplying artery), time lapse be-
tween embolisation and surgery, estimated blood loss, and complications related to embolisation
were evaluated.
Conclusion:
Pre-operative angiographic assessment of patients with convexity or skull base meningiomas
provides important information for determining the surgical approach, and when combined with
embolisation may facilitate a more complete resection of these surgically challenging lesions.
The procedure represents a safe option for selected meningiomas.
Due to variation in the reported efficacy and complication rates, the utility of embolisation re-
mains incompletely defined. Future clinical research is needed in order to define the patients that
are most likely to benefit from this procedure.
Key Words: Intracranial Meningioma, Brain Surgery, Endovascular Embolisation