Contemporary management of meningiomas: radiation therapy as an adjuvant and radiosurgery as an alternative to surgical removal?

S we proceed into the second century of diagnosis and management of intracranial meningiomas, the proper mixture of definitive surgery and radiation therapy techniques continues to be analyzed. Both the reports of Goldsmith, et al.,S and Maroon, et at., '3 define a series of patients who benefited from a judicious balance of multimodality management strategies for their meningeal tumors. Modern microsurgical techniques, cranial nerve electrophysiological monitoring, enhanced neuroanesthesia regimens, and superior postoperative rehabilitative services have improved considerably the overall mortality and morbidity statistics for meningioma surgery? Surprisingly, a number of controversial questions remain to be answered despite our more than 100 years of experience.