Surgical management of giant intracranial meningioma: operative nuances, challenges and outcome.

Surgical management of giant intracranial meningioma: operative nuances, challenges and outcome.

World Neurosurg. 2017 Oct 05;:

Authors: Narayan V, Bir SC, Mohammed N, Savardekar AR, Patra DP, Nanda A

Abstract
INTRODUCTION: The giant intracranial meningioma [GIM] constitutes a different spectrum of brain tumors which invade the vital neurovascular structures and makes the primary mode of treatment, surgery, a technically challenging one. The surgery of GIM is unique due to its large size, prominent vascularity, entangling and limited visualisation of various neurovascular structures and severe cerebral edema. The study reports the authors surgical experience of 80 GIM cases, the operative challenges and surgical outcome.
METHODS: A retrospective analysis of 80 patients of histologically proven meningioma of size ≥ 5cm who underwent surgical treatment at LSU Health Sciences Center, Shreveport, Louisiana, USA over twenty year period [1995-2015] is presented. The clinical and radiological data was collected from the hospital database. The tumours were categorised into histological groups according to WHO classification. The relevant statistical analysis of the study was conducted using SPSS software, version 22.0.
RESULTS: The study included 27 males [33.8%] and 53 females [66.3%]. The mean age of the cohort was 56 years [56.3±16.1]. The mean size of the tumor was 56.4 ±4 mm with a range from 50 mm to 84 mm. Skull base was the most common location of GIM [57 patients, 71.3%]. Simpson Grade 1 excision was achieved in 9 patients [11.3%] whereas Grade 2 excision was achieved in 57 patients [71.3%]. 80% of the tumors belonged to WHO grade 1. The operative mortality was seen in 4 patients [5%]. Regression analysis showed age, sex, location of the tumor, neuronavigation, Simpson grade of excision, and histology of tumor were the factors which significantly affected the recurrence free survival [RFS].
CONCLUSION: The surgery for GIM is unique in different ways. As surgery for GIM is formidable, radiological characteristics can be useful adjuncts for planning an effective and safe surgical strategy. The factors such as young age, male sex, use of neuronavigation and skullbase location positively influenced RFS while Simpson Grade of excision [Grade 3/Grade 4] and poor histological grade adversely influenced RFS. A careful pre-operative evaluation, understanding of the risk factors, effective surgical approach and judicious use of intra-op adjuncts are the key factors which play a pivotal role in GIM resection.

PMID: 28987827 [PubMed - as supplied by publisher]

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