However, some general guidelines for the treatmeni of these tumors can be outlined. For those with mild or non-progressive symptoms, it may be appropriate to follow the patient with periodic MRI and examination to determine if the lesion is growing and to see whether the symptoms are significantly interfering with the pafient's life. Radiotherapy is used in older patients with small and medium size tumors with worsening symptoms and for regrowth after subtotal or radical subtotal removal. For most patients, a lateral subfrontal and anterior temporal exposure is used. Internal decompression of the tumor is done staying away from the region of the internal carotid and middle cerebral arteries.
Some soft tumors can be more easily removed than very firm, hard tumors.
The distal branches of the middle cerebral artery are identified and followed to the tumor capsule to determine if it is feasible to dissect them. In some situations arachnoid planes help in separating the tumor from and around the encased arteries. At some point, the relationship of the optic nerve and chiasm to the tumor is determined. In my series of 16 patients treated over a 15 year period, there were 12 females and four males ranging in age from 28-79 years with two over 70 years of age. One patient had a postoperative intracerebral hemorrhage two weeks after surgery and has a permanent dysphasia and hemiparesis.