Evaluation of surgical outcome of giant intracranial meningiomas

Abstract

BackgroundThe 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 bodyA 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.ConclusionManagement 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.