Al-Mefty’s Meningiomas, 2nd editionEditors: Franco DeMonte, MD; Michael W. McDermott, MD; and Ossama Al-Mefty, MD
Publisher: Thieme – 432 pages
Book Review by: Nano Khilnani

Meningiomas are a group of inflammatory tumors in the brain (to some extent in the spinal cord). They arise from membranous layers in the brain called meninges, particularly from ‘cap’ cells of the arachnoid villi. The meninges are in the three-layered connective tissue separating the brain from the skull. The three layers consist of dura mater (‘hard mother’), arachnoid mater (‘spidery mother’) and pia mater (‘tender mother’).

Most meningiomas are typically benign exhibiting no symptoms in patients, but a small percentage is malignant or cancerous. Either conventional surgery or radiosurgery can be used to treat patients with meningiomas.

The purpose of this book is to provide updated information and insight on meningiomas to medical students, residents, fellows and practitioners of neurology and neurosurgery.

Dr. Ossama Al-Mefty has had many years of experience in neurosurgery. He and his co-editors Dr. Thomas C. Origitano and Dr. H. Louis Harkey developed the book Controversies in Neurosurgery 20 years ago in 1996.

Much has been learned about meningiomas and other tumors since then. As a matter of fact, as Dr. Mitchel Berger writes in his Foreword to this book, “meningioma management has become a very complex, multifaceted process in the daily lives of all neurosurgeons. Meningiomas are extraordinarily complex lesions that require a different set of surgical skills and judgment than what we use for other tumors such as gliomas.”

Eighty-eight specialists in neurology, neuropathology, neurosurgery, pituitary surgery, radiology, radiation oncology, radiosurgery, skull base surgery, as well as anesthesiology and medical research, from 12 countries – Australia, Austria, Brazil, Canada, France, Germany, Italy, Japan, Sudan, Taiwan, and Turkey, and the United States – authored the 44 chapters that are allocated in 11 Sections, which we list below to give you an overview of the contents of this book:

  1. Section I – Introduction
  2. Section II – Anatomy and Pathology
  3. Section III – Molecular Biology and Laboratory Techniques
  4. Section IV – Clinical Considerations
  5. Section V – Preoperative Considerations
  6. Section VI – Diagnostic Radiology
  7. Section VII – Surgical Treatment of Intracranial Meningiomas By Site
  8. Section VIII – Special Operative Considerations for Intracranial Meningiomas
  9. Section IX – Surgical Treatment of Spinal Meningiomas
  10. Section X – Adjuvant Treatment
  11. Section XI – Special Considerations

With a wide range of topics covered in this second edition, the chapter authors share the latest information on the anatomy, biology, epidemiology, and pathology of meningiomas. They write about meningiomas in children and the elderly, radiation-induced and multiple meningiomas, and what happens to people if their meningiomas are left untreated.

There are chapters in this book that cover risk evaluation and anesthesia administration for intracranial and spinal meningioma patients, and the treatment and management of patients before, during, and after their operative procedures. Other chapters discuss imaging options and techniques, diagnostic evaluation, and embolization of meningiomas.

The largest of the 11 sections of this book is VII, Surgical Treatment of Intracranial Meningiomas By Site, which contains chapters 15 through 34 that cover a range of surgical procedures to treat many kinds of meningiomas, such as: cavernous sinus, cerebellar, cerebellopontine, clinoidal, clivial and petroclivial, convexity, falcotentorial, falx, foramen and magnum, lateral and middle sphenoid, olfactory, parasagittal, peritorcular, sphenoorbital, temporal bone, tentorial, tubercullum and sellae meningiomas.

Also covered in Section VII are mengingiomas of the lateral and fourth ventricles, of the third ventrical and pineal region, and of the middle fossa floor.

Particular considerations need to be taken into account for surgeries on some types of meningiomas in the brain, and chapters dealing with them are grouped together in Section VIII. These discuss image-guided surgical techniques, the use of magnetic resonance imaging in resection of meningiomas, surgical management of cerebral venous sinuses, and the use of endoscopy in the management of meningiomas.

Likewise for surgery on meningiomas in the spinal tract, chapter 30 in Section IX deals with the relevant issues. Chapters dealing with radiation techniques, stereotactic radiosurgery, and chemotherapy in dealing with meningiomas are found in Section X. Lastly, some reflective thought on meningioma surgery – including experience, volume of care, patient outcomes, and post-surgery quality of life – is found in chapters 43 and 44 in the last Section.

This book has a vast amount of well-organized material in text and image formats. You will find a lot of detailed black-and-white and full-color anatomical drawings, and images seen through microscopes illustrating different types of meningiomas and their anatomy and physiology. Besides these, there are radiographs, computed tomography scans, and magnetic resonance imaging scans.

This is an authoritative, definitive, extensive, well-planned and well-executed, and highly useful, valuable text on intracranial and spinal meningiomas, with in-depth coverage of diagnosis, medical treatment, and surgical procedures. It is a must-have book for the medical library of any well-equipped neurologist, neuroradiologist, neurosurgeon, or practitioner in an allied specialty.



Franco DeMonte. MD is Professor of Neurosurgery and Head and Neck Surgery, and Mary Beth Pawelek Chair in Neurosurgery at the University of Texas M.D. Anderson Center in Houston, Texas.

Michael W. McDermott, MD is Professor and Vice-Chairman of the Department of Neurosurgery; Director of Patient Care Services; Co-director of Skull Base Surgery and Gamma Knife Radiosurgery Programs; and Robert and Ruth Halperin Chair in Meningioma Research at University of California – San Francisco in San Francisco, California.

Ossama Al-Mefty, MD. FACS is Director of Skull Base Surgery in the Department of Neuro surgery at Brigham and Women’s Hospital at Harvard Medical School in Boston, Massachusetts.



Mitchel S. Berger, MD, FACS, FAANS is Professor and Chairman of the Department of Neurological Surgery at the University of California – San Francisco in San Francisco, California.