Convexity Meningioma Surgery (Craniotomy)
Convexity meningioma surgery is a neurosurgical procedure in which benign tumors arising from the membranes covering the outer surface of the brain (the convexity) are removed via craniotomy. Removing the tumor and the involved membrane as completely as possible aims to reduce the likelihood of recurrence.
Ostatnia aktualizacja: 2026-06-09
Definition
Meningiomas are mostly benign, slow-growing tumors arising from the membranes (meninges) surrounding the brain and spinal cord. A convexity meningioma denotes a tumor located over the outer surface of the brain, relatively distant from major vascular structures; this location makes surgical access more direct than other skull base locations. In surgical treatment, the tumor is reached through a craniotomy, in which part of the skull is temporarily removed. The aim is to remove the tumor and the involved membrane to an appropriate extent, relieve pressure on the brain, and obtain a tissue diagnosis.
Indications
Convexity meningioma surgery is considered for tumors demonstrated on imaging (usually contrast-enhanced MRI) that are symptomatic or show a tendency to grow. Seizures, headache, neurological deficits related to the tumor's location (weakness, speech or vision changes), or marked signs of compression support the decision for surgery. Small, asymptomatic, non-growing meningiomas may in some cases be followed with regular imaging rather than surgery. The decision is made by considering the tumor's size, location, growth rate, and the patient's age, general condition, and symptoms together.
Procedure
The procedure is performed under general anesthesia; the patient is positioned according to the tumor's location and the head is fixed. After the skin and muscle layers are opened, a bone flap is removed from the skull (craniotomy) to reach the dura, which is then opened. Working under the operating microscope, the tumor is carefully separated from the surrounding brain tissue; its feeding vessels are controlled and it is removed as completely as possible together with the involved dura. The extent of removal is usually described using the Simpson grading system; the involved membrane and, when needed, the adjacent bone are also assessed. After hemostasis, the dura is repaired, the bone flap is replaced, and the layers are closed; the removed tissue is sent for pathological examination.
Advantages and Limitations
The convexity location represents a relatively surgically accessible group among meningiomas and, in many cases, allows wide removal of the tumor together with the involved membrane; complete removal can reduce the likelihood of recurrence. Surgery also provides a definitive tissue diagnosis. However, the size of the tumor, its proximity to brain tissue, and its relationship to important vessels or functional areas can limit the extent of removal. The tumor grade (benign, atypical, or malignant) influences the course and the need for additional treatment; some cases may require postoperative radiotherapy or surveillance. Not every meningioma requires surgery.
Recovery and Risks
Recovery time varies with the tumor's location, size, and the patient's general condition; patients are usually kept under neurological observation for a period. Possible risks include bleeding, infection, brain swelling, seizures, cerebrospinal fluid leak, and transient or permanent neurological deficits related to the tumor's location. Even when the tumor is completely removed, recurrence may occur over time and follow-up with regular imaging is needed. No outcome is guaranteed; the decision is individualized by considering the patient's clinical status, imaging findings, pathology result, and expectations together.
Źródła
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:803-817.
- DeMonte F, McDermott MW, Al-Mefty O, eds. Al-Mefty's Meningiomas. 2nd ed. Thieme; 2011:135-141.
- Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry. 1957.
- Goldbrunner R, et al. EANO guideline on the diagnosis and management of meningiomas. Neuro-Oncology. 2021.
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