Meningioma Surgery & Treatment in New York City

Advanced Surgical Management • Skull Base & Complex Meningiomas • Network-Preserving Techniques

Overview

Meningiomas are tumors that arise from the membranes surrounding the brain and spinal cord. Many grow slowly and can be safely observed, while others require treatment because of tumor growth, neurological symptoms, brain compression, or involvement of critical structures such as cranial nerves, blood vessels, venous sinuses, or functional brain networks.

Randy S. D’Amico, MD, is a neurosurgical oncologist at Lenox Hill Hospital in New York City who specializes in surgery for meningiomas, including skull base tumors, tumors involving critical brain networks or venous sinuses, recurrent meningiomas, and other complex or high-risk lesions.

Treatment is individualized based on tumor size, location, growth, symptoms, imaging characteristics, age and overall health. Depending on these factors, the best approach may be observation, surgery, radiation, or a combination of treatments.

Types of Meningiomas Treated

  • WHO grade 1 meningiomas

  • WHO grade 2 meningiomas

  • WHO grade 3 meningiomas

  • Skull base meningiomas, including olfactory groove, tuberculum sellae, planum sphenoidale, petroclival and cavernous sinus tumors

  • Parasagittal and falcine meningiomas

  • Meningiomas involving major venous sinuses

  • Convexity meningiomas

  • Recurrent or previously irradiated meningiomas

  • Tumors involving motor, language, visual, or other critical functional networks

Each requires individualized planning based on tumor size, location, and relationship to surrounding structures.

When Does a Meningioma Need Surgery?

Not every meningioma requires an operation. Small tumors that are discovered incidentally, are not causing symptoms, and remain stable on serial imaging can often be monitored.

Surgery may be considered when a meningioma:

- Is growing on serial MRI

- Causes seizures or neurological symptoms

- Produces significant brain compression or swelling

- Affects vision, movement, language, balance, or other neurological functions

- Compresses cranial nerves or important blood vessels

- Involves the skull base or venous sinuses in a way that threatens neurological function

- Has imaging or clinical features concerning for more aggressive behavior

- Recurs or progresses after previous treatment

The decision to operate depends not only on tumor size but also on its location, growth rate, symptoms, biological behavior, and the risks associated with treatment.

Common Symptoms

Meningioma symptoms vary depending on location:

  • Headaches

  • Seizures

  • Weakness or numbness

  • Speech or language changes

  • Vision problems

  • Balance or gait difficulty

  • Personality or cognitive changes

  • Smell loss (olfactory groove tumors)

  • Facial numbness or double vision (skull base tumors)

Any new neurological symptom should prompt evaluation.

Diagnosis & Evaluation

Evaluation includes:

  • MRI with contrast using tumor-focused protocols

  • CT scan to evaluate bone involvement

  • Functional MRI (fMRI) when near language/motor regions

  • Connectomics analysis to understand network relationships

  • Review of prior imaging to assess growth rate

  • Tissue biopsy or resection for grading (when indicated)

A detailed review allows for informed decision-making about observation, surgery, radiation, or a combination.

Meningioma Surgery

The goal of meningioma surgery is maximal safe removal of the tumor while preserving neurological function. Complete removal may be appropriate for some tumors, while deliberately leaving tumor behind can be safer when it is densely associated with critical nerves, blood vessels, venous sinuses, or brain networks. Residual tumor can sometimes be monitored or treated with focused radiation.

Connectomics-Guided Planning

For selected meningiomas involving or displacing critical brain networks, structural and functional connectomics can provide additional information about the relationship between the tumor and pathways involved in movement, language, and other functions. This information can be integrated with conventional imaging, intraoperative mapping, and surgical anatomy when planning the operation.

Minimally Invasive & Keyhole Approaches

Selected meningiomas may be accessible through smaller or less invasive surgical approaches, including eyebrow/keyhole craniotomy or endoscopic-assisted techniques. The appropriate approach is determined by tumor anatomy rather than incision size—the priority is obtaining adequate surgical access while protecting the surrounding brain, nerves, and blood vessels.

Skull Base Meningiomas

Meningiomas arising along the skull base can involve the optic nerves, carotid arteries, cranial nerves, brainstem, and other critical structures. Examples include olfactory groove, planum sphenoidale, tuberculum sellae, cavernous sinus, and petroclival meningiomas.

Treatment may involve observation, surgery, radiation, or a combined strategy. In some cases, intentionally leaving tumor attached to a critical structure and treating or monitoring the residual disease may provide a better balance between tumor control and neurological function than attempting complete removal.

Conventional Craniotomy for Complex Lesions

For larger or skull base tumors, a tailored craniotomy provides optimal exposure to safely remove the tumor while protecting nerves, venous sinuses, and vital structures.

Recurrent Meningiomas

A meningioma that grows after previous surgery or radiation requires reassessment of the original pathology, growth pattern, tumor location, previous treatments, and available molecular information. Depending on the circumstances, options may include repeat surgery, stereotactic radiosurgery, fractionated radiation, brachytherapy in selected cases, clinical trials, or continued observation.

For higher-grade or repeatedly recurrent tumors, molecular profiling may also help characterize tumor biology and identify potential clinical-trial options.

Non-Surgical Treatment Options

Some meningiomas can be managed without surgery, including:

  • Observation for small, asymptomatic tumors

  • Stereotactic radiosurgery (SRS)

  • Fractionated radiotherapy

  • Combined surgery + radiation when maximal safe resection isn’t possible

Dr. D’Amico collaborates closely with radiation oncology and neuro-oncology to determine the best strategy based on the tumor’s grade, biology, and behavior.

Second Opinions for Meningioma

A second opinion can be particularly useful when:

  • Surgery has been recommended for an incidentally discovered meningioma

  • A tumor involves the skull base, venous sinuses, or critical brain networks

  • Different physicians have recommended surgery versus observation or radiation

  • Complete removal is expected to carry substantial neurological risk

  • A meningioma has recurred after previous treatment

  • The tumor has been described as difficult, high-risk, or inoperable

  • Imaging shows unexpected growth or changing characteristics

A second opinion does not necessarily mean surgery will be recommended. The goal is to independently assess whether observation, surgery, radiation, or a combined strategy provides the best balance of tumor control and neurological function.

Meningioma Care in New York City

Patients are evaluated and treated at Lenox Hill Hospital in Manhattan, with second-opinion consultations available for patients throughout New York, the tri-state area, and beyond.

Request a Meningioma Consultation or Second Opinion

If you have been diagnosed with a meningioma and would like to understand whether observation, surgery, radiation, or another treatment strategy is appropriate, you can request an evaluation at Lenox Hill Hospital in New York City.

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