CHAPTER 16 Meningiomas: Science and Surgery

Meningiomas are perhaps the most fascinating braintumors in neurosurgery.3,6,8,10–12,32,52 Although “be-nign ” in most cases, they create major problems for patients and doctors in decision making and management. Biologi-cally, they raise important questions regarding hormonal dependence, genetic predispositions to tumors, and radiation. Studies into their biology and treatment are sparsely funded by government agencies, and patient advocacy has become very important in their care. Attitudes to their management range from observation through radiation to very aggressive attempts to remove the entire tumor. This paper will discuss science and surgery for menin-giomas. The science will include meningioma models, mo-lecular epidemiology, and new treatments. It will primarily reflect work performed in the Meningioma laboratory at the Brigham and Women’s Hospital (BWH) in the past 10 years and the emerging Meningioma Project supported by the Brain Science Foundation at the BWH. The references cited in this paper will be almost completely from our group and our collaborators—they are not meant to be a comprehensive list. In surgery for meningiomas, we will discuss outcome from one surgeon’s (PB) surgical series of 733 patients with meningioma surgery. Meningiomas aptly reflect the themes of this issue of Clinical Neurosurgery and of the 2006 CNS meeting—tran-scendent leadership in science, patient care, and mentorship. They also reflect three important subthemes—history, glob-alism, and patient advocacy. HISTORY In neurosurgery, we owe a great deal to our predeces-sors. We, therefore, start by paying tribute to some of the giants who paved the way for studies in meningiomas. Chief of these is Harvey Cushing, the surgeon-in-chief at the Pete