MENINGIOMA (NYC)

Advanced Surgical Management • Minimally Invasive Approaches • Network-Preserving Techniques

Overview

Meningiomas are the most common primary brain tumor in adults, arising from the protective layers (meninges) surrounding the brain and spinal cord. While many meningiomas grow slowly, others can cause significant symptoms when they compress important structures—especially when located near eloquent brain networks, the skull base, venous sinuses, or cranial nerves.

As a neurosurgical oncologist at Lenox Hill Hospital in Manhattan, Dr. Randy S. D’Amico specializes in the evaluation and surgical treatment of complex meningiomas, including tumors in challenging locations, recurrent lesions, and cases requiring advanced mapping techniques. His approach emphasizes precision, safety, and preservation of speech, motor, and cognitive function.

Types of Meningiomas Treated

  • WHO Grade I (benign)

  • WHO Grade II (atypical)

  • WHO Grade III (anaplastic)

  • Skull base meningiomas (olfactory groove, tuberculum, petroclival, cavernous sinus, planum sphenoidale)

  • Parasagittal and falcine meningiomas

  • Meningiomas near venous sinuses

  • Recurrent or previously irradiated meningiomas

  • Meningiomas affecting critical networks (motor, language, SMA)

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

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.

Surgical Approach

Connectomics-Guided Planning

For meningiomas involving eloquent regions or deep networks, Dr. D’Amico uses structural and functional connectomics to plan the safest surgical corridors and minimize disruption to critical pathways.

Minimally Invasive & Keyhole Approaches

When appropriate, surgical access can be achieved through:

  • Eyebrow/keyhole craniotomies

  • Endoscopic assistance

  • Tubular corridors

  • Exoscopic visualization

These techniques may reduce recovery time and cosmetic impact.

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

Management may include:

  • Reoperation

  • Targeted radiation (SRS or fractionated therapy, brachytherapy)

  • Consideration of systemic therapy in atypical/anaplastic cases

  • Tumor molecular profiling to guide therapy

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

Patients often seek Dr. D’Amico for:

  • Tumors in challenging or eloquent locations

  • Skull base meningiomas

  • Recurrent meningiomas after surgery or radiation

  • Clarification of surgical vs. radiation risks

  • Connectomics-guided surgical planning

  • Unexpected tumor regrowth or new symptoms

Second opinions are often available promptly.

Serving New York City & the Tri-State Area

Patients with meningiomas are evaluated and treated at Lenox Hill Hospital (100 E 77th St, New York, NY 10075), accessible to patients from:

  • Manhattan

  • Brooklyn

  • Queens

  • The Bronx

  • Long Island

  • Westchester

  • Northern New Jersey

Next Steps

If you or a loved one has been diagnosed with a meningioma:

  • Request a Consultation

  • Seek a Second Opinion

  • Refer a Patient

  • Return to Conditions Treated for additional diagnoses