Surgical Management of Giant Intracranial Meningioma: Operative Nuances, Challenges, and Outcome

Narayan, Vinayak; Bir, Shyamal C.; Mohammed, Nasser; Savardekar, Amey; Patra, Devi Prasad; Nanda, Anil

doi:10.1016/j.wneu.2017.09.184

Cited by 38 publications

(53 citation statements)

References 18 publications

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“…This study included cases with tumor size less than 5 cm while in our study the minimum tumor size was more than 6 cm. In this study, most cases were of skull base type, WHO grade I, and Simpson grade II excision was the most commonly achieved mode of surgical treatment with higher intraoperative mortality than our series (5% while it was 0% in our study) [5].…”

Section: Discussioncontrasting

confidence: 48%

“…Meningiomas arise from arachnoid cap cells; these tumors account for the second most frequent type of brain adult tumors representing 20% of all brain tumors [2][3][4]. The giant intracranial meningioma (GIM) represents specific type of brain tumors which include and surround the vital neurovascular structures making the usual regimen of treatment, surgery, a technically challenging treatment option [5].…”

Section: Introductionmentioning

confidence: 99%

“…Despite different modes of treatment used for meningioma, surgery is the primary and main mode of treatment due to pressure manifestations and inclusion of the brain stem, cranial nerves, and brain vasculature [6]. The surgery of GIM is difficult due to its huge volume, high vascularity, included several neurovascular structures limiting its visualization, and marked brain edema [5]. Total surgical removal of giant skull base meningiomas is technically challenging and so hard due to its attachment and inclusion of the skull base vital structures either vascular or neurological [6].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of surgical outcome of giant intracranial meningiomas

Teama¹,

Adawy²,

Emara³

2020

Egypt J Neurosurg

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Background The surgery of giant intracranial meningiomas (GIM) is difficult due to its large size, prominent vascularity, including and limiting visualization of various neurovascular structures, and severe cerebral edema. In this study, we will evaluate the surgical outcome of giant meningiomas according to our experience at our hospital in management of giant intracranial meningioma. Main body A retrospective analysis of 48 patients with histologically proven meningioma (≥ 6-cm diameter) who underwent surgical treatment at Benha University hospitals over a period of 5 years (June 2014/June 2019) is presented. Details regarding clinical presentation, imaging findings, surgical results and complications, and follow-up status were collected. The study group was composed of 41 females and 7 males. The age of the study group ranged from 38 to 69 years with an average of 49 years. The mean follow-up period was 36 months. Different approaches were used according to tumor location with the aim of gross total removal. Gross total removal was achieved in 90% of cases (43 cases). There were 2 cases with intraoperative complications not related to surgery. Recurrence was present in 4 cases. Mortality in this series was 4% (2 cases) with no reported intraoperative mortality. Conclusion Management of giant intracranial meningioma is a relatively common practice in neurosurgical centers in developing countries with the aim of radical total surgical removal being the first and most optimum option. Large size makes surgery difficult, but young age, meticulous surgical techniques, proper localization, trying to minimize operative time, and Simpson grade are of special value. Interdisciplinary cooperation is essential to avoid the common complications like pulmonary embolism (PE), postoperative hematoma in tumor bed that leads to bad surgical outcome.

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Section: Discussioncontrasting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of surgical outcome of giant intracranial meningiomas

Teama¹,

Adawy²,

Emara³

2020

Egypt J Neurosurg

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“…7 A recent report found that 20% of giant meningiomas (i.e., > 5 cm) were WHO grade II or III. 21 Furthermore, in that study, tumor location also influenced recurrence-free survival. Another retrospective analysis reported that tumor size was related to disease-free survival for patients with atypical meningiomas who received radiotherapy.…”

Section: Interpretation Of Resultsmentioning

confidence: 68%

Relationship between tumor location, size, and WHO grade in meningioma

Magill¹,

Young²,

Chae³

et al. 2018

Neurosurgical Focus

136

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OBJECTIVEPrior studies have investigated preoperative risk factors for meningioma; however, no association has been shown between meningioma tumor size and tumor grade. The objective of this study was to investigate the relationship between tumor size and grade in a large single-center study of patients undergoing meningioma resection.METHODSA retrospective chart review of patients undergoing meningioma resection at the University of California, San Francisco, between 1985 and 2015 was performed. Patients with incomplete information, spinal meningiomas, multiple meningiomas, or WHO grade III meningiomas were excluded. The largest tumor dimension was used as a surrogate for tumor size. Univariate and multivariate logistic regression models were used to investigate the relationship between tumor grade and tumor size. A recursive partitioning analysis was performed to identify groups at higher risk for atypical (WHO grade II) meningioma.RESULTSOf the 1113 patients identified, 905 (81%) had a WHO grade I tumor and in 208 (19%) the tumors were WHO grade II. The median largest tumor dimension was 3.6 cm (range 0.2–13 cm). Tumors were distributed as follows: skull base (n = 573, 51%), convexity/falx/parasagittal (n = 431, 39%), and other (n = 109, 10%). On univariate regression, larger tumor size (p < 0.001), convexity/falx/parasagittal location (p < 0.001), and male sex (p < 0.001) were significant predictors of WHO grade II pathology. After controlling for interactions, multivariate regression found male sex (OR 1.74, 95% CI 1.25–2.43), size 3–6 cm (OR 1.69, 95% CI 1.08–2.66), size > 6 cm (OR 3.01, 95% CI 1.53–5.94), and convexity/falx/parasagittal location (OR 1.83, 95% CI 1.19–2.82) to be significantly associated with WHO grade II. Recursive partitioning analysis identified male patients with tumors > 3 cm as a high-risk group (32%) for WHO grade II meningioma.CONCLUSIONSLarger tumor size is associated with a greater likelihood of a meningioma being WHO grade II, independent of tumor location and male sex, which are known risk factors.

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“…Papilledema can be followed later by secondary optic atrophy. Giant meningioma is considered a tumor with more than 5 cm in size (5). The location of the tumor and the surrounding structure determined the prognosis of surgery management.…”

Section: Introductionmentioning

confidence: 99%

Giant Parasagittal Meningioma with Complete Visual Loss in Young Female: A Case Report

Sinaga

Irsyad

Dharmajaya

2021

JKB

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<p>Parasagittal meningioma is a benign extra-axial tumor from the arachnoid cap cell that fills the parasagittal angle. This case report presents a case of a 21-years old young female with a history of complete visual loss, left side paresthesia, and progressive blunt headache. Brain MRI and MRV revealed a giant enhancing tumor measuring 9.2 cm x 8.41 cm x 7.5 cm on the right parietooccipital lobe with obstruction of the posterior third of the superior sagittal sinus. Gross total removal was achieved. The pathology reports confirmed a WHO grade I meningioma. The paresthesia and headache were improved, but the loss of visions did not change. Giant parasagittal meningioma may invade the superior sagittal sinus leading to intracranial hypertension. The surgical strategy should target the survival and postoperative quality of life. Occlusion of posterior third superior sagittal sinus affects deficiency venous return resulting in visual loss.</p>

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Surgical Management of Giant Intracranial Meningioma: Operative Nuances, Challenges, and Outcome

Cited by 38 publications

References 18 publications

Evaluation of surgical outcome of giant intracranial meningiomas

Evaluation of surgical outcome of giant intracranial meningiomas

Relationship between tumor location, size, and WHO grade in meningioma

Giant Parasagittal Meningioma with Complete Visual Loss in Young Female: A Case Report

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