Original ArticleSurgical Management of Giant Intracranial Meningioma: Operative Nuances, Challenges, and Outcome
Introduction
The giant intracranial meningioma (GIM) constitutes a different spectrum of brain tumors that invade the vital neurovascular structures and make the primary mode of treatment, surgery, a technically challenging one. The surgery for GIM is unique because of the large size of the tumor, prominent vascularity, entangling and limited visualization of various neurovascular structures and severe cerebral edema.1, 2 It usually arises in an area of maximal brain compliance; therefore, it may grow large before becoming symptomatic and being diagnosed.3 We consider the tumors more than 5 cm in maximum dimension as GIM in our series.2, 3, 4, 5, 6
Currently, different protocols are applied for meningioma tumors, including simple observation, partial resection, radiosurgery as primary or adjuvant therapy, and aggressive surgical removal. Usually this kind of large meningioma lesion requires surgery because of its mass effect and neurovascular involvement.7 The surgery for GIM is usually associated with a myriad of complications.8 The surgical strategy should be focused on survival and postoperative quality of life. The intricate location of tumor, the direction of growth, invasion of adjacent structure, patient age, and the experience of the surgeon are the key factors when choosing the best surgical approach for these lesions. The study reports the authors' experience with surgical management of 80 cases of GIM, its operative challenges, and surgical outcomes.
Section snippets
Materials and Methods
A retrospective analysis of 80 patients of histologically proven meningioma measuring 5 cm or larger who underwent surgical treatment at Louisiana State University Health Sciences Center, (Shreveport, Louisiana, USA) over a 20-year period is presented. Information related to clinical history, neuroimaging such as computed tomography (CT) and magnetic resonance imaging (MRI), use of neuronavigation, microsurgical dissection and outcomes of patients with meningiomas between January 1995 and
Demographics and Clinical Parameters
The demographic data for 80 patients who underwent surgical intervention (January 1995 to December 2015) were analyzed. The study included 27 men (33.8%) and 53 women (66.3%). The mean age of the cohort was 56.3 years with SD of 16.1 years. On analysis of only older patients, we found 53 patients (66.3%) of which 18 were male (22.5%) and 35 (43.7%) were female. Forty-seven patients (58.8%) were white, 25 patients were African American (31.3%), and the remaining 8 patients (10%) were Hispanic.
Discussion
GIM usually shows a female preponderance and occurs around the age of 40 years.4 The clinical manifestations of tumor can vary according to the location. The most common clinical manifestation was headache (57.5%), and the most common tumor location was the skull base (71.3%) in the present study. A previous study reviewed the patients with supratentorial meningioma (n = 255) and analyzed the location of the tumors in descending order: cerebral convexity (27%), parasagittal sinus (20.7%),
Conclusion
The surgery for GIM is unique in different ways for various reasons. As surgery for GIM is formidable, clinicoradiologic characteristics can be useful adjuncts for planning an effective and safe surgical strategy. Safe, maximal resection should be the goal, especially for GIMs located at the skull base. We found that factors such as young age, male sex, use of neuronavigation, and skull base location positively influenced the RFS, whereas Simpson grade of excision (grade 3/4) and poor
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.