Staged Resection of Difficult-to-Treat Intracranial Meningiomas: A Systematic Review of the Indications, Surgical Approaches, and Postoperative Outcomes

Abstract

Introduction: Meningiomas are extra-axial intracranial tumors that are characterized as benign and slow-growing intracranial tumors of the dura. Large meningiomas encroach on critical vascular and neural structures, sometimes making gross total resection challenging. Multi-staged surgeries are becoming increasingly utilized as they can help improve safe resection while minimizing adverse sequela. Methods: PubMed, Scopus and Web of Science databases were queried to identify articles reporting resections of intracranial meningiomas using a multi-staged approach, and articles were screened for possible inclusion in a systematic process performed by two authors. Results: Of 118 identified studies, 36 describing 169 patients (mean age 42.6±21.3 years) met inclusion/exclusion criteria. Petroclival lesions comprised 57% of cases, with the most common indications for a multi-staged approach being large size, close approximation of critical neurovascular structures, minimization of brain retraction, identification and ligation of deep vessels feeding the tumor, and resection of residual tumor found on postoperative imaging. Most second stage surgeries occurred within 3 months of the index surgery. Few complications were reported and multi-staged resections appeared to be well tolerated overall. Conclusions: Current literature suggests multi-staged approaches for meningioma resection are well-tolerated. However, there is insufficient comparative evidence to draw definitive conclusions about its advantages over an unstaged approach. There are similarly insufficient data to generate an evidence-based decision-making framework for when a staged approach should be employed. This highlights the need for collaborative efforts amongst skull base surgeons to establish an evidentiary to support the use of staged approaches.

Surgical Approaches to Resection of Olfactory Groove Meningiomas: Comparative Meta-analysis of the Endoscopic Endonasal versus Transcranial and Unilateral versus Bilateral Approaches

“…4 Additionally, by approaching from the dural base of the tumor, the EEA potentially increases the odds of Simpsons grade 1 resection and may consequently help to improve local recurrence rates. 5,6 EEA is not without limitations though and may be associated with higher rates of cerebrospinal fluid (CSF) leak and olfactory dysfunction than transcranial approaches (TCA).…”