Convexity meningioma surgery indications

With the conservative recommendations for surgery for asymptomatic meningiomas and the advent of radiosurgery during the past 10 years, microsurgically treated convexity meningiomas are now typically large in size 1). Nevertheless, the patient's clinical course following microsurgical removal of these lesions is expected to be uncomplicated. 2) 3).

If the convexity meningioma is symptomatic or growing and the patient is of an age in which surgery is appropriate.

If the meningioma is large and has a rich vascular supply, its amenable for a pre-surgery embolization.

The resection of the meningiomas surrounding the dura is an important goal during the removal of a convexity meningioma.

Simpson Grade I resection should continue to be the goal for convexity meningiomas 4).

da Silva et al. present the first application of sodium fluorescein (SF) as a tool for tumor and dural tail identification in convexity meningiomas.

Five frontal convexity meningiomas operated on between December 2012 and April 2013 were included. After initial dissection a dose of 1 g of the SF, 20% was injected into a peripheral vein. Tumor and dural tail were removed using the correlation between magnetic resonance imaging (MRI) findings and transoperative SF enhancement.

Simpson Grade 1 removal was obtained in three cases, grade 2 in one atypical meningioma and grade zero in one case. SF dural tail enhancement was positive in all cases and histologic analysis evidenced involvement of the dura by tumors.

SF enhancement was evident in meningiomas and dura surrounding the lesions. Histologic analysis confirmed dural involvement. SF could represent an universally available fluorescent tool for meningioma surgery 5).

1) , 3)
Sanai N, Sughrue ME, Shangari G, Chung K, Berger MS, McDermott MW. Risk profile associated with convexity meningioma resection in the modern neurosurgical era. J Neurosurg. 2010 May;112(5):913-9. doi: 10.3171/2009.6.JNS081490. PMID: 19645533.
Morokoff AP, Zauberman J, Black PM. Surgery for convexity meningiomas. Neurosurgery. 2008 Sep;63(3):427-33; discussion 433-4. doi: 10.1227/01.NEU.0000310692.80289.28. PMID: 18812953.
Hasseleid BF, Meling TR, Rønning P, Scheie D, Helseth E. Surgery for convexity meningioma: Simpson Grade I resection as the goal: clinical article. J Neurosurg. 2012 Dec;117(6):999-1006. doi: 10.3171/2012.9.JNS12294. Epub 2012 Oct 12. PubMed PMID: 23061394.
da Silva CE, da Silva VD, da Silva JL. Convexity meningiomas enhanced by sodium fluorescein. Surg Neurol Int. 2014 Jan 14;5:3. doi: 10.4103/2152-7806.124978. eCollection 2014. PubMed PMID: 24575318; PubMed Central PMCID: PMC3927087.
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