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Craniotomy for meningioma, by a skull-base neurosurgeon.

A clinically reviewed guide to surgery for meningioma - WHO grade, Simpson resection, skull-base considerations, and when stereotactic radiosurgery or watch-and-wait is the better answer.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What meningioma surgery and radiosurgery cost privately in London.

Indicative ranges across UK private providers.

In short

£18,000–£28,000, typical stay 4–7 days.

Procedure Indicative range
Neurosurgical consultation £300–£600
Volumetric MRI brain with contrast £600–£1,200
Craniotomy for convexity meningioma £18,000–£28,000
Craniotomy for skull-base meningioma £28,000–£45,000
Stereotactic radiosurgery (single fraction) £8,000–£16,000
Fractionated external beam radiotherapy £10,000–£20,000

Prices vary by tumour location and grade, by the neurosurgeon and clinic, by intraoperative adjuncts (neuronavigation, monitoring, awake mapping) and by length of hospital stay.

The problem

The right operator, the right operation - and sometimes, no operation at all.

Meningioma decisions are quietly complex - grade, size, location, symptoms and age all interact. We make sure the plan comes from a neuro-oncology MDT, not a single opinion.

  • Is surgery even needed?

    For a small, asymptomatic incidentaloma - especially in older patients - watch-and-wait is often the right answer. We say so before you agree to surgery.

  • Convexity or skull-base?

    Skull-base tumours belong in the hands of a subspecialist neurosurgeon who does that anatomy routinely - not a generalist.

  • Surgery or radiosurgery?

    Small, residual or recurrent tumours are often better treated with stereotactic radiosurgery than repeat craniotomy. That trade-off should be weighed openly.

When it helps

When craniotomy for meningioma is the right step.

The situations we see most - plus the red flag that means an emergency rather than an outpatient appointment.

  • Symptomatic meningioma

    Headache, focal weakness, seizures, visual field loss or cognitive change from tumour mass effect - the commonest reason to operate.

  • Growing incidentaloma

    A small meningioma found by chance that has grown on serial MRI - intervention is discussed rather than continued watching.

  • Convexity or parasagittal tumour

    Superficial tumours over the cerebral convexity or straddling the sagittal sinus - often suitable for a Simpson grade I resection.

  • Skull-base meningioma

    Sphenoid wing, olfactory groove, tuberculum sellae, cavernous sinus, cerebellopontine angle or foramen magnum - technically demanding, cranial-nerve territory.

  • Atypical or anaplastic (WHO II / III)

    Higher-grade meningiomas need maximal safe resection and, usually, adjuvant radiotherapy - the surgical target is aggressive.

  • Watch-and-wait

    Small, asymptomatic tumours in older or frail patients are often best served by serial imaging - not every meningioma needs surgery.

  • Stereotactic radiosurgery

    Small residual, recurrent or surgically inaccessible tumours are often treated with single-fraction SRS rather than open surgery.

  • Red flag: rapid deterioration

    Sudden severe headache, new focal deficit, reduced consciousness or a first-ever seizure is a same-day emergency - A&E, not a clinic booking.

Treatment options

Craniotomy is not the only option.

What each pathway actually involves - from watchful waiting through Simpson grade I resection to stereotactic radiosurgery and external beam radiotherapy.

  • Watch-and-wait

    Small, asymptomatic incidentalomas - especially in older patients - are monitored with serial MRI. Only tumours that grow or cause symptoms are treated.

  • Simpson grade I resection

    The tumour, its dural attachment and any involved bone are all removed. Historically the lowest recurrence risk - the surgical ideal where the location allows.

  • Simpson grade II–III resection

    Tumour removed with coagulation (II) or without treatment of the dural attachment (III) - used where sinuses or cranial nerves prevent a grade I.

  • Subtotal (Simpson IV) resection

    Partial resection of a skull-base or sinus-invading tumour - a deliberate compromise to protect cranial nerves, arteries or venous sinuses.

  • Stereotactic radiosurgery (SRS)

    A single high-dose treatment for small tumours (<3 cm), residual disease after subtotal resection, or recurrence - no craniotomy required.

  • Fractionated external beam RT

    Standard adjuvant treatment for atypical (WHO II) and anaplastic (WHO III) meningiomas, and for larger or eloquent-location tumours unsuitable for SRS.

  • Embolisation before surgery

    For vascular tumours - especially sphenoid wing or convexity - pre-operative endovascular embolisation reduces intra-operative blood loss.

Safety and recovery

What to expect - honestly, by tumour location.

Convexity meningioma surgery is well-tolerated. Skull-base surgery carries a real and specific set of risks - cranial nerves, venous sinuses, CSF pathways - that deserve to be spelled out before consent.

  • Recurrence depends on grade and Simpson

    WHO grade I with a Simpson grade I resection has the lowest recurrence risk. Atypical (II) and anaplastic (III) tumours recur more often, even after complete surgery.

  • Cranial nerve injury (skull-base)

    Sphenoid wing, cavernous sinus and cerebellopontine angle tumours sit against cranial nerves - vision, eye movement, facial sensation and hearing can all be affected.

  • Venous sinus injury (parasagittal)

    Parasagittal and falcine tumours straddle the sagittal sinus. Complete resection is not always safe - the alternative is a subtotal resection plus radiotherapy.

  • CSF leak and meningitis

    Skull-base approaches carry a small risk of a persistent cerebrospinal fluid leak, which can occasionally lead to meningitis and needs prompt attention.

  • Seizures on eloquent locations

    Convexity meningiomas near motor or language cortex can cause post-operative seizures. Anticonvulsants are often used peri-operatively.

  • Hydrocephalus after skull-base surgery

    Posterior fossa and foramen magnum surgery can disturb CSF flow. A small proportion of patients need a shunt or endoscopic third ventriculostomy.

  • Radionecrosis after SRS

    Stereotactic radiosurgery can - uncommonly - cause radiation necrosis months to years later. It is managed with steroids and, occasionally, bevacizumab.

  • Hormonal factors

    Meningiomas express progesterone receptors and can grow in pregnancy or with hormonal treatments. This is factored into the plan and follow-up.

  • Red flags

    A new focal deficit, first-ever seizure, worsening headache or reduced consciousness after surgery are not normal - call the neurosurgical team or A&E the same day.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whether the surgery was for a convexity or skull-base meningioma, the note the neurosurgeon sends you keeps to the same shape.

A UK consultant neurosurgeon reviewing a patient’s post-operative MRI

A quiet reminder

Neurosurgical language is precise - and can read alarmingly. We translate it for you.

If you would like us to talk you through the note and the post-operative MRI before your follow-up, just ask.

  1. 01 Header

    Location, grade and Simpson resection

    Where the meningioma sat, its WHO grade on histology (I benign, II atypical, III anaplastic), and the Simpson grade of resection achieved.

  2. 02 Technique

    Approach, monitoring and adjuncts

    The craniotomy approach used, whether neuronavigation and intraoperative monitoring were employed, and whether pre-operative embolisation was performed.

  3. 03 Findings

    Cranial nerves, sinuses and residual

    Notes on cranial nerve preservation, involvement of venous sinuses, whether any tumour was deliberately left behind, and immediate post-operative status.

  4. 04 Impression

    Adjuvant plan and follow-up MRI

    Read this first: whether adjuvant SRS or external beam radiotherapy is planned, and when the follow-up MRI is scheduled.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Meningioma surgery is generally covered by major UK insurers when medically indicated.

Frequently asked

Everything we get asked about meningioma surgery.

Quick answers on WHO grade, Simpson resection, skull-base risks, stereotactic radiosurgery, and when watch-and-wait is the right answer.

  • What is a meningioma?

    A meningioma is a tumour that arises from the arachnoid cap cells of the meninges - the layers that cover the brain and spinal cord. Most are slow-growing and benign (WHO grade I), a minority are atypical (WHO grade II) or anaplastic (WHO grade III).

  • Does every meningioma need surgery?

    No. Small, asymptomatic incidentalomas - particularly in older or frail patients - are often watched with serial MRI. Surgery is offered when a tumour causes symptoms, grows on scans, or is likely to cause problems given its size and location.

  • What is the Simpson grade?

    The Simpson grading system describes how completely a meningioma has been removed. Grade I means the tumour, its dural attachment and any involved bone are all excised - the lowest recurrence risk. Grades II–V describe progressively less complete resections.

  • What does WHO grade I, II or III mean?

    The WHO grade reflects how the tumour looks under the microscope. Grade I is benign and the commonest. Grade II (atypical) is more likely to recur. Grade III (anaplastic) is malignant and always needs radiotherapy after surgery.

  • What is stereotactic radiosurgery (SRS)?

    SRS delivers a single, high dose of precisely targeted radiation to a small tumour without opening the skull. It is used for small meningiomas, residual disease after subtotal resection, and recurrent tumours - as an alternative to further surgery.

  • Do I need radiotherapy after craniotomy?

    Not for a Simpson grade I resection of a WHO grade I meningioma. Atypical (WHO II) tumours are often offered adjuvant radiotherapy, especially after subtotal resection. Anaplastic (WHO III) tumours are always treated with radiotherapy after surgery.

  • What are the risks of skull-base meningioma surgery?

    Cranial nerve injury (vision, eye movement, facial sensation, hearing), CSF leak, meningitis, sinus injury, seizures, hydrocephalus and - for higher grades - recurrence and malignant transformation over time. Risk profile depends heavily on tumour location.

  • How long is the hospital stay?

    Typically four to seven days for a convexity meningioma and five to ten days for a skull-base case, including a short neuro-ICU period. Recovery to normal activities usually takes six to twelve weeks.

  • Can hormones or pregnancy affect a meningioma?

    Yes. Meningiomas commonly express progesterone receptors and can grow during pregnancy or with certain hormonal treatments (including some progestins). This is factored into decision-making and follow-up.

  • When should I seek urgent medical help?

    A first-ever seizure, sudden severe headache, new weakness, speech difficulty, visual loss or reduced consciousness - before or after surgery - is a same-day emergency. Attend A&E rather than waiting for a clinic appointment.

Related treatments

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In practice, in London

What craniotomy of meningioma looks like on the ground in London

For craniotomy of meningioma, the private London route is mostly about consultant fit and hospital choice rather than raw waiting time. Public provision for craniotomy of meningioma is competent but constrained by capacity. Private London clinics tend to have shorter diaries and longer appointment slots, so you get the same specialists with more time. For people who’ve been going round in circles with primary care, that first proper conversation is often what shifts things.

A typical private booking for craniotomy of meningioma in London starts with a consultant conversation - sometimes in person on Harley Street or Marylebone, sometimes on video if that suits better. Any imaging or diagnostics happen at a nearby CQC-registered facility, and reports usually land within 24 to 72 hours. The whole loop, from first call to written report, is often done inside a fortnight. For craniotomy of meningioma in particular, we bias towards consultants who do this every week rather than every month.

The value is knowing which consultant reads this particular presentation best, which unit turns reports around fastest, and which pathway won’t hit a dead end if the findings point somewhere unexpected.