Surgery — Surgery is indicated in almost all cases. The goal of surgery is to establish the diagnosis, alleviate mass-related symptoms, and remove as much tumor as is safely possible. Some neurosurgeons advocate a strategy of reduction of neural compression by cyst drainage and limited resection of solid tumor in anticipation of irradiation of residual tumor. Many others argue that the initial operation offers the best chance for surgical cure and attempt complete total tumor removal when it can be accomplished with a low risk of neurologic injury.
Preoperative management should include treatment of disease-related complications that may be present and can increase the risk associated with surgery: