Surgical management of meningiomas associated only with headache.

Indication for surgery evolve with time and the development of technical refinements. Currently, in the MRI era, the opportunity for improved diagnosis has increased posing new dilemmas for treatment. Meningiomas are benign tumors with a still obscure growing rate. Radical removal is the treatment of choice and conservative attitude is adopted only in rare cases. It is generally agreed that incidental meningiomas, including patients with small tumors presenting headache, can be followed up. In order to investigate if there exists any relation between meningiomas and headache-not intra- cranial hypertension-related-we reviewed 514 cases operated on since 1990 for intracranial meningiomas. Patients with papilledema, vomiting or midline shift on CT or MRI and patients in which headache was not the predominant symptom were excluded from the series. Six patients met the inclusion criteria. Analysis of clinical and radiological findings demonstrated that the overall series presented small tumors (less than 3 cm) located in the convexity. Calcifications were present in 5 cases, bone erosion and hyperostosis in I case each. Headache resolved in all patients during the perioperative period. No morbidity nor mortality was found. Although this series is small, we noted recurrent features in patients with meningiomas with headache and benefit from surgery: small size, convexity location and calcifications. Although we were reluctant to operate on healthy people, in which headache is not intracranial hypertension-related, these preliminary results confirm the rela- tion between specific meningiomas and headache, offering a new perspective in the management of patients with meningiomas with/or persistent headache.