Resection Of Meningioma Research Articles

Microsurgical Resection of Giant Left Clinoid Meningioma: The Meticulous Dissection of Encased Blood Vessels and Bleeding Control Using the Yasargil “Welding” Technique: A 2-Dimensional Operative Video

Microsurgical Resection of Giant Left Clinoid Meningioma: The Meticulous Dissection of Encased Blood Vessels and Bleeding Control Using the Yasargil “Welding” Technique: A 2-Dimensional Operative Video

Virtual reality for patient informed consent in skull base tumors and intracranial vascular pathologies: A pilot study.

With the growing demand for shared decision-making and patient-centered care, optimal informed consent (IC) has gained relevance. Virtual reality (VR) has seen significant technological advancements, and its medical applications currently include surgical planning and medical education. This pilot study investigates the feasibility of VR-enhanced informed consent (VR-IC) in neurosurgery to improve preoperative IC and patient satisfaction. We included patients aged 18 to 75years who were scheduled for skull base meningioma or brain aneurysm surgery between May and December 2023. Exclusion criteria were visual/auditory impairments and severe cognitive/psychiatric disorders. Patients received standard IC followed by VR-IC using patient-specific VR models of their pathology. After an initial demonstration by the surgeon, the patients used the VR station independently. A questionnaire with 18 questions on a 5-point Likert scale assessed the subjective impression of VR-IC. Ten patients participated in the study, with six (60%) undergoing aneurysm clipping and four (40%) undergoing skull base meningioma resection. The mean age of the participants was 58years (± 15, range 27 to 75years), with four female patients (40%). Patients overall rated the VR-informed consent (VR-IC) positively with a mean of 4.22 (± 0.84). There was a better understanding of their pathology (mean 4.30 ± 0.92) and the planned procedure (mean 3.95 ± 1.04). Trust in the surgeon was rated with a mean of 3.47 (± 0.94). Only minimal side effects from the VR experience including dizziness or discomfort were noted (mean 4.60 ± 0.22). None of the participants dropped out of the study. VR-enhanced informed consent is feasible and improves patient understanding and satisfaction without significant side effects. These findings will guide the planning of a randomized controlled trial to validate the benefits of VR-IC in neurosurgery further.

SURG-13. PATHOLOGICAL EXAMINATION OF MENINGIOMA RECURRENCE AFTER ABSORBABLE ARTIFICIAL DURA MATER RECONSTRUCTION

Abstract INTRODUCTION In meningioma surgery, the removal of the tumor and tumor-attached dura mater is essential. Due to its high affinity, absorbable artificial dura mater is used for the reconstruction of dural defects. In this study, we report a pathological examination of dural-like tissue in a case of meningioma that recurred at the same site after the use of absorbable artificial dura mater during initial surgery. METHOD We investigated two cases in which absorbable artificial dura mater was used for dural reconstruction during meningioma resection, and subsequently, a recurrent lesion was identified at the site of the dural reconstruction. We examined MRI images and surgical and pathological findings at the time of recurrence in these cases. RESULT All patients underwent total resection, and the pathological diagnosis was atypical meningioma. MRI images at the time of recurrence revealed multiple meningiomas along the artificial dura site. Gross findings during recurrent surgery indicated that the absorbable dura had been replaced by dura-like tissue, with the tumor also attached to the same site. Pathological findings showed bundles of fibrous tissue within the dura-like tissue, albeit with a sparser density compared to autologous dura mater. Meningioma cell invasion and angiogenesis were also observed in the dural-like tissue. DISCUSSION In all cases, multiple meningiomas were found along the dural-like tissue. This suggests that meningioma cells invading the dural-like tissue may have used it as a scaffold for meningioma recurrence. Future studies are necessary to determine the appropriateness of absorbable artificial dura mater for dural defect sites during malignant meningioma surgery.

SURG-41. OPTIMIZING PATIENT OUTCOMES IN PETROCLIVAL MENINGIOMA TREATMENT: EVALUATING SURGICAL, RADIOSURGICAL, RADIOTHERAPY AND COMBINED TREATMENT APPROACHES

Abstract Petroclival meningiomas pose a formidable challenge due to their proximity to critical neurovascular structures, necessitating complex surgical interventions with a high risk of complications. Stereotactic radiosurgery (SRS) offers an alternative or complementary treatment option, yet the optimal treatment strategy remains undefined. We aimed to evaluate the local control rates following surgical resection, radiotherapy, and SRS for petroclival meningiomas and to assess the incidence of cranial nerve palsies associated with each treatment modality. This retrospective study reviewed medical records of patients treated for petroclival meningiomas at Stanford University between 1980-April 2024. Pre- and post-treatment radiological data were analyzed to assess local control. Cranial nerve function was evaluated pre- and post-treatment, and at last follow-up. A total of 171 patients (129 females; median age 54.65 years) diagnosed with petroclival meningioma were identified. Treatment modalities included: 31 patients underwent surgical resection alone, 27 received SRS alone, 11 received radiotherapy alone, 36 underwent combined surgical resection and SRS, 28 received combined surgical resection and radiotherapy, 9 were treated with a triad of surgical resection, SRS, and radiotherapy, and 29 were managed with serial imaging alone. The percentage change of tumor volume from diagnosis to follow-up for these groups was -55.6%, 28.9%, 73.0%, -64.9%, -12.0%, 35.3%, and -8.8%, respectively. The incidence of new cranial nerve palsies was highest (68%) in patients who underwent surgical resection. The percentage of worsening pre-existing palsies was greater in patients receiving single-modality non-surgical treatment. Surgery, radiotherapy, and SRS demonstrated promising local control rates for specific patient cohorts with petroclival meningiomas. Patients receiving combination therapies generally fared better than those receiving single-modality treatments, with surgery followed by SRS yielding the best outcome. The incidence of cranial nerve palsies was lower following SRS and radiotherapy compared to surgery. Future research should focus on refining multi-modal treatment strategies to minimize complications and improve patient quality of life.

Immediate and long-term results of microsurgical resection of tentorial meningiomas

Aim. To optimize the choice of surgical approach based on the assessment of immediate and long-term results of microsurgical treatment of cerebellar meningiomas.Materials and methods. Between 2019 and 2023 at the Department of Neurosurgery of the m.f. vladimirsky moscow Regional Research Clinical Institute, 24 patients with primary meningiomas of the cerebellum underwent microsurgical treatment. The ratio between women and men was 5:1, mean patient age was 51.5 years. mean tumor volume was 8.7 cm3. Neurological and neuroimaging data, information about concomitant disorders, surgical protocols, information on postoperative complications, functional outcomes, and catamneses of the patients were compiled.Results. Total tumor resection was achieved in 22 (91.7 %) cases, subtotal in 2 (8.3 %) cases with grade I–II radicality per the Simpson classification. Deterioration and neurologic deficit were observed in 5 (20.8 %) patients. In 2 (8.3 %) patients, dysfunction of the abducens nerve was observed, in 3 (12.5 %) – impaired hearing or deafness, in 5 (20.8 %) – ataxia aggravation. postoperative complications developed in 2 (8.3 %) patients. No deaths were registered. grade 1 meningiomas were found in 22 (91.7 %) patients, grade 2 – in 2 (8.3 %) patients.Conclusion. During microsurgical removal of tentorial meningiomas, optimal surgical approach takes into account the topographic and anatomical location of the tumor. This makes it possible to achieve safe and effective treatment with favorable functional outcomes.

NCOG-44. EXPLORING THE IMPACT OF PRE-OPERATIVE MAJOR DEPRESSIVE DISORDER ON POSTOPERATIVE OUTCOMES IN PATIENTS UNDERGOING SURGICAL EXCISION OF MENINGIOMAS

Abstract INTRODUCTION Meningiomas are prevalent brain tumors that can cause significant morbidity for patients. Major depressive disorder (MDD), especially in the setting of other medical conditions, is associated with poor prognoses and increased mortality. This study aims to investigate whether pre-operative MDD is a risk factor for postoperative mortality and cognitive impairment in patients with meningiomas undergoing surgical excision. METHODS A retrospective cohort study was conducted using the TriNetX database including adults undergoing craniotomy for meningioma excision, one group comprising patients with pre-operative MDD and the other without. Propensity-score matching was performed to control for age, sex, race, ethnicity, history of cognitive impairment, neurodegenerative diseases, other psychiatric disorders, and socioeconomic barriers to care. Primary outcomes were postoperative mortality, depressive episodes, and cognitive impairment measured within 5 years postoperatively. RESULTS After matching, the study included 289 patients per cohort. Postoperative mortality rates for patients with pre-operative MDD compared to those without were similar (11.42% vs 9.69%, RR: 1.179, 95% CI: 0.732-1.898). Patients with MDD had a significantly higher prevalence of postoperative depressive episodes compared to those without MDD (64.71% vs 38.06%, RR: 1.7, 95% CI: 1.434-2.015). There were no statistically significant differences between the two groups in the prevalence of attention and concentration deficits (5.88% vs 4.15%, RR: 1.417, 95% CI: 0.689-2.913), cognitive communication deficits (8.99% vs 6.57%, RR: 1.368, 95% CI: 0.775-2.416), or executive function deficits (3.46% vs 3.46%, RR: 1, 95% CI: 0.423-2.366). CONCLUSION This study suggests no significant relationship between pre-operative MDD and post-operative mortality and cognitive deficits in patients undergoing meningioma resection. However, the risk of experiencing a depressive episode within 5 years post-operation is very high, especially in those with pre-operative MDD. Therefore, preoperative psychiatric evaluation and postoperative monitoring in patients with meningiomas and MDD are crucial. Further research is warranted to elucidate underlying mechanisms and relationships.

DDEL-12. LOCAL DELIVERY OF CHEMOTHERAPIES VIA BIORESORBABLE IMPLANT IN MENINGIOMAS

Abstract Many meningiomas recur despite repeated surgical resections and radiation, and patients must undergo progressively morbid surgical procedures due to recurrent or progressive disease. However, unlike most gliomas, meningiomas do not diffusely infiltrate throughout the brain on a single-cell basis, but instead recur and invade locally. Thus, they may be particularly vulnerable to localized chemotherapy. To investigate this, we screened 13 patient-derived primary meningioma cell cultures and two commercially available meningioma cell lines using a library of 147 FDA-approved compounds. We identified drugs with elevated potency across all meningiomas, including bortezomib (mean IC50 = 7nM) and romidepsin (mean IC50 = 18nM), as well as drugs with selective potency against specific samples, such as docetaxel (IC50 range 6nM to >10uM). We reasoned that delivery of a multi-drug cocktail with independent anti-neoplastic mechanisms would provide the strongest therapeutic effect in meningiomas. As systemic treatment with combination agents resulted in severe toxicity in mice, we performed local injection of bortezomib / romidepsin / docetaxel (BRD) triple therapy over 24 days in flank xenografts of IOMM-LEE and CH157 meningiomas. Tumor growth was reduced by 71-88% relative to vehicle (p<0.01), and mice showed no systemic toxicity with local therapy. Notably, the addition of radiotherapy did not further enhance the effect of BRD. To optimize local delivery, we developed a polyanhydride bioresorbable wafer designed to fit in a meningioma resection cavity, analogous to carmustine wafers used in gliomas. Intracranial implantation of wafers caused no local toxicity or inflammation in mice. Docetaxel-loaded wafers prevented the growth of flank-injected IOMM-LEE cells relative to wafers without drug (0 mm3 vs. 230 mm3 at 3 weeks post-injection, N=5/group, p<0.01). Our results demonstrate that bioresorbable wafers containing a cocktail of potent chemotherapies may be an effective new strategy against locally aggressive meningiomas.

SURG-25. PREOPERATIVE EMBOLIZATION IMPROVES LOCAL CONTROL AND REPROGRAMS GENE EXPRESSION IN ATYPICAL WHO GRADE 2 MENINGIOMAS

Abstract Preoperative embolization is hypothesized to reduce blood loss and surgical time for meningioma resection, but the impact of embolization on long-term clinical outcomes and molecular profiling of meningiomas is incompletely understood. To address this, we evaluated the impact of embolization on outcomes and molecular features of WHO grade 2 meningiomas. A series of patients with grade 2 meningiomas who underwent resection at our institution from 1997 to 2021 were identified and reviewed. Available DNA methylation profiling and bulk RNA sequencing data were analyzed (n=200). Univariate and multivariate analyses, Cox proportional hazards modeling, and propensity matching (sex, age at surgery, previous surgery, extent of resection, postoperative radiation) were used. A total of 357 patients with WHO grade 2 meningiomas were included, 129 (36.1%) of which underwent preoperative embolization. Mean age at diagnosis was 53.5 years and 61.4% of patients were female. There was no significant difference in time to recurrence with or without embolization for cases with gross total resection (229/357), but embolization was independently associated with improved local control for cases with subtotal resection even after accounting for postoperative radiotherapy (HR 0.49, 95% CI 0.32-2.20 p=0.028). The average time to recurrence of atypical WHO grade 2 meningioma was 3.3 years after subtotal resection and 6.7 years after embolization and subtotal resection (p<0.001, propensity matched). The distribution of Merlin-intact vs Immune-enriched vs Hypermitotic meningioma DNA methylation groups was equivalent with versus without embolization, but differential gene expression analysis of RNA sequencing data revealed enrichment of hypoxia related pathways after embolization that were unique to each DNA methylation group. In summary, these data show that preoperative embolization improves local control and reprograms gene expression in atypical WHO grade 2 meningiomas. Additional investigation into the impact of embolization on clinical outcomes and gene expression for meningiomas, especially for higher-grade tumors, is warranted.

PATH-59. HISTOLOGIC CORRELATES FOR MOLECULAR FEATURES IN MENINGIOMAS

Abstract Histologic findings are the primary determinant of meningioma prognosis and post-operative management. However, the association of specific pathologic features with molecular alterations has not yet been comprehensively investigated. Here we utilized a large dataset of well-characterized meningiomas to identify correlates between clinically relevant histological and molecular features. Detailed histologic information was collected for 809 resected meningiomas, including cases with DNA methylation (n=380), copy number array (n=252), next-generation sequencing (n=52), RNA risk score (n=394), and/or TERT promoter profiling (n=238). Analyses were conducted on prognostic pathologic features, including WHO Grade, Ki-67, mitotic index (MI), brain invasion, and atypical histologic findings (necrosis, hypercellularity, prominent nucleoli, sheeting, and small cells). Correlation with molecular variables was performed using Fisher’s Exact Tests, including DNA methylation subgroup, RNA risk score, CNV profiles, and TERT promoter mutations. All statistics were corrected for multiple hypothesis testing. Nearly 65% of meningiomas exhibited at least one atypical histologic feature. Among said features, Ki-67/MI, WHO Grade, sheeting, and necrosis were associated with recurrent lesions and known clinical features of aggressive meningiomas. Several histologic features, including hypercellularity, elevated Ki-67/mitotic index, and WHO grade, also correlated with DNA methylation and RNA risk groups. Several chromosomal arm events were related to specific pathologic features (prominent nucleoli, Ki-67, MI, and grade), including chromosomes 1, 4, 10, 14, and 18. Our analysis highlights the continued value in screening for histologic markers of aggressive behavior in meningiomas, as they correlate with the presence of high-risk molecular features and may serve as proxy markers when advanced molecular testing is not available.

EXTH-53. THE PHARMACOLOGICAL ATLAS OF MENINGIOMAS

Abstract No systemic treatment options exist for recurrent or refractory meningioma patients. This study aimed to create a pharmacological atlas of all FDA-approved oncology drugs in a large cohort of patient-derived meningioma organoids (TOs). TOs were generated from single cell suspensions from freshly resected meningiomas and were treated with semi-logarithmic concentrations spanning from 10 nM to 30 µM by the automated liquid handler Hamilton MicroLAB STAR®. The drug library AODX from the National Cancer Institute consisted of 179 FDA-approved anticancer drugs. The viability was measured with the RealTimeGlo (Promega). Half-maximal inhibitory concentrations (IC50) were calculated by GraphPad Prism software. We created a pharmacological atlas of meningiomas by generating 8,413 dose-response curves of 179 current FDA-approved oncology drugs in patient-derived tumor organoids from 47 meningioma patients. The cohort consisted of 35 grade 1, 11 grade 2, and 1 grade 3 meningiomas, including 10 recurrent tumors. In total, 21% (n=39/179) of the drugs exhibited sensitivity (median IC50 < 30 µM), with significant enrichment for topoisomerase, RNA/protein synthesis, proteasome, and HDAC inhibitors. The top five drugs with the lowest IC50 values were romidepsin, dactinomycin, carfilzomib, plicamycin, and omacetaxine with median values of 10, 31, 145, 303, and 400 nM. Hierarchical clustering of IC50 data revealed at least two distinct drug response clusters defined by sensitivity to tyrosine kinase inhibitors. When considering the Cmax/IC50 ratio as a potential predictive marker of treatment response (>1), the HDAC inhibitors belinostat (74.5), romidepsin (69.7), the proteasome inhibitor carfilzomib (34.6), and the anthracyclines epirubicin (2.6), and doxorubicin (1.8), and the PI3K inhibitor idelalisib (1.6) are the most promising drug candidates for further in vivo evaluation. We provide the first comprehensive insight into the pharmacological landscape of meningiomas. This data might serve as the foundation for future clinical studies on the systemic treatment of aggressive meningiomas.

Analysis of the Predictability of Postoperative Meningioma Resection Status Based on Clinical Features

Background: Our aim was to investigate the predictability of postoperative meningioma resection status based on clinical features. Methods: We examined 23 clinical features to assess their effectiveness in distinguishing gross total resections (GTR) from subtotal resections (STR). We analyzed whether GTR/STR cases are better predictable if the classification is based on the Simpson grading or the postoperative operative tumor volume (POTV). Results: Using a study cohort comprising a total of 157 patients, multivariate models for the preoperative prediction of GTR/STR outcome in relation to Simpson grading and POTV were developed and subsequently compared. Including only two clinical features, our models showed a notable discriminatory power in predicting postoperative resection status. Our final model, a straightforward decision tree applicable in daily clinical practice, achieved a mean AUC of 0.885, a mean accuracy of 0.866, a mean sensitivity of 0.889, and a mean specificity of 0.772 based on independent test data. Conclusions: Such models can be a valuable tool both for surgical planning and for early planning of postoperative treatment, e.g., for additional radiotherapy/radiosurgery, potentially required in case of subtotal resections.

Endonasal Endoscopic Resection of a Large Tuberculum Sellae Meningioma With Internal and External Carotid Artery Blood Supply: 2-Dimensional Operative Video.

Endonasal Endoscopic Resection of a Large Tuberculum Sellae Meningioma With Internal and External Carotid Artery Blood Supply: 2-Dimensional Operative Video.

Multi-parameter MRI radiomics model in predicting postoperative progressive cerebral edema and hemorrhage after resection of meningioma

BackgroundPostoperative progressive cerebral edema and hemorrhage (PPCEH) are major complications after meningioma resection, yet their preoperative predictive studies are limited. The aim is to develop and validate a multiparametric MRI machine learning model to predict PPCEH after meningioma resection.MethodsThis retrospective study included 148 patients with meningioma. A stratified three-fold cross-validation was used to split the dataset into training and validation sets. Radiomics features from the tumor enhancement (TE) and peritumoral brain edema (PTBE) regions were extracted from T1WI, T2WI, and ADC maps. Support vector machine constructed different radiomics models, and logistic regression explored clinical risk factors. Prediction models, integrating clinical and radiomics features, were evaluated using the area under the curve (AUC), visualized in a nomogram.ResultsThe radiomics model based on TE and PTBE regions (training set mean AUC: 0.85 (95% CI: 0.78–0.93), validation set mean AUC: 0.77 (95%CI: 0.63–0.90)) outperformed the model with TE region solely (training set mean AUC: 0.83 (95% CI: 0.76–0.91), validation set mean AUC: 0.73 (95% CI: 0.58–0.87)). Furthermore, the combined model incorporating radiomics features, and clinical features of preoperative peritumoral edema and tumor boundary adhesion, had the best predictive performance, with AUC values of 0.87 (95% CI: 0.80–0.94) and 0.84 (95% CI: 0.72–0.95) for the training and validation set.ConclusionsWe developed a novel model based on clinical characteristics and multiparametric radiomics features derived from TE and PTBE regions, which can accurately and non-invasively predict PPCEH after meningioma resection. Additionally, our findings suggest the crucial role of PTBE radiomics features in understanding the potential mechanisms of PPCEH.

Exploring the Potential Use of Virtual Reality with a Supraorbital Keyhole Craniotomy for Anterior Skull Base Meningiomas: Two Case Reports

Introduction: A supraorbital keyhole craniotomy (SOKC) is a novel alternative to frontal craniotomies for accessing the anterior fossa for resecting tumors and clipping aneurysms; however, its implementation is limited in patients at a high risk of complications. We present two cases involving the use of augmented reality (AR) and virtual reality (VR) for patient selection and preoperative planning for a supraorbital tumor resection of anterior fossa meningiomas. Methods: This is a prospective, single-center case series at a research institute. We identified patients with an anterior or middle fossa meningioma regardless of age, gender, and tumor characteristics who could undergo an SOKC and MRI. The preoperative planning was performed with the BrainLab Magic Leap AR/VR platform. The meningiomas were resected through the SOKC under neuronavigation. Results: We identified two cases: a 37-year-old male with a meningioma in the sellar region and an 84-year-old male with a right anterior fossa meningioma, both confirmed by MRI. Both patients had a complete tumor resection by a minimally invasive SOKC after preoperative planning with the AR/VR platform. Postoperatively, hyponatremia complicated the first case, while the second case developed an intracranial hemorrhage. They both recovered after the appropriate interventions. Conclusions: The use of an SOKC for anterior skull base meningiomas should be individualized after considering the lesion characteristics, vascular control needs, and the surgeon’s expertise. VR/AR-assisted preoperative evaluation and planning will optimize the patient selection and surgical outcomes. We can utilize VR/AR technologies to identify patients that will benefit from an SOKC and expand the implementation of the approach beyond its current limitations.

Twelve-year experience of pineal region meningiomas: long-term outcomes of maximal safe resection.

The purpose of this research was to summarize the clinical and prognostic features of pineal region meningiomas, evaluate treatment strategies and long-term prognoses, and improve the management of pineal region meningiomas. We retrospectively studied the data of 37 patients who received surgical resection for pineal region meningiomas at West China Hospital of Sichuan University from 2009 to 2021. Adjuvant gamma knife radiosurgery (GKRS) was conducted according to the extent of resection (EOR). Progression-free survival (PFS), Karnofsky performance status (KPS) scores and recovery of neurological function were adopted to assess a comprehensive management strategy for pineal region meningiomas. The most common symptom was headache associated with intracranial hypertension (75.7%). The occipital transtentorial approach (40.5%) and supracerebellar infratentorial approach (29.7%) were performed in most cases. Gross total resection (GTR) was achieved in 27 patients (73.0%) and the remaining patients were treated with subtotal resection (STR) combined with postoperative GKRS. With a mean follow-up period of 87.0 months, the progression rate was 10.0%, the 5-year PFS rate was 92.9%, and the ΔKPS was 16.3. Multivariate analysis revealed that the STR + GKRS and supracerebellar infratentorial approach were beneficial to the recovery of quality of life of patients. Pineal region meningiomas are sporadic but challenging. It is necessary to select the most appropriate surgical approach, EOR, and hydrocephalus treatment strategy for patients with pineal region meningiomas. Maximal safe resection to protect neurovascular function combined with postoperative GKRS can significantly improve the quality of life of patients.

MNGA-01 ÉPILEPSIE LIÉE AU MÉNINGIOME: À PROPOS DE DEUX CAS

Abstract BACKGROUND Meningiomas are the most common intracranial primary neoplasms. Seizures are a common manifestation of these tumors (10% to 50%). PURPOSE To present 2 cases of meningioma-related epilepsy and discuss the predictive factors for preoperative and postoperative seizures, their physiopathology and their management. CASE REPORTS The first patient is a 36-years-old male with a 16 years history of epilepsy revealing an underlying left frontoparietal meningioma which benefited from a Simpson grade 1 surgical resection with a seizure free postoperative outcome. The second patient is a 46-years-old man with a 6 months history of seizures revealing a right parieto-occipital meningioma requiring surgical removal with persistence of seizures on postoperative follow-up. CONCLUSION Seizures are a common occurrence both prior to and after meningioma resection, and can have a significant negative impact on patient quality of life. Further efforts are required for better understanding and predicting seizures in meningioma as well as plan their medical treatment.

Preoperative Radiographic Features Independently Predict High Blood Loss During Intracranial Meningioma Resection: A Case-Control Study

Surgical resection of intracranial meningioma carries the risk of several complications, including intraoperative blood loss. The objective of this study was to investigate preoperative clinical and radiographic factors predictive of intraoperative estimated blood loss (EBL). This case-control study evaluated EBL for all adults who underwent intracranial meningioma resection from January, 2010 to December, 2021 at our institution. Fifty cases of high EBL (i.e., ≥500mL) and 75 instances of low EBL (i.e., <500mL) were randomly selected. Patients were excluded if they had a recurrent meningioma, preoperative embolization, or lack of imaging data. A multivariable logistic regression model of high EBL likelihood was created. A total of 92 patients met eligibility criteria, with 48 (52%) cases of high EBL. Bivariable analyses identified maximal tumor diameter, intratumoral flow voids, skull base location, and dural venous sinus invasion as potential predictors of high EBL. Multivariable regression found intratumoral flow voids (adjusted odds ratio [aOR]= 5.68 [1.52-21.23], P= 0.009), maximal tumor diameter (aOR= 1.58 [1.11-2.25] per 1-cm increase, P= 0.01), and skull base location (aOR= 3.35 [1.19-9.41], P= 0.02) to be independent predictors of high EBL. Intratumoral flow voids, larger maximal tumor diameter, and skull base location were independently predictive of EBL ≥500mL. Intratumoral flow void presence was the strongest predictor, with 5.68 times the odds of high EBL. Each 1-cm increase in tumor diameter had 58% greater odds of high EBL. Skull base location was associated with 3.35 times the odds of high EBL. These results can inform preoperative patient counseling and blood management preparation.

Hearing Loss in the Unoperated Ear After High-Speed Drilling in Otologic and Skull Base Surgery.

To evaluate if permanent hearing loss occurred in the unoperated ear of patients undergoing otologic and skull base surgery with high-speed otologic drilling. We retrospectively studied 250 patients (mean age 57.8 yr; 120 males, and 130 females) undergoing otologic or skull base surgery with high-speed drilling between 2013 and 2019. The University of Pittsburgh Medical Center. We evaluated preoperative and postoperative audiograms for patients undergoing surgery for cochlear implantation (95 patients, 38.0%), cholesteatoma or chronic ear disease (88 patients, 35.2%), repair of lateral skull base encephalocele (26 patients, 10.4%), resection of vestibular schwannoma or meningioma of the cerebellopontine angle (23 patients, 9.2%), lateral temporal bone resection (8 patients, 3.2%), microvascular decompression (7 patients, 2.8%), or other operations involving a high-speed otologic drill (3 patients, 1.2%). Hearing threshold shift, measured as the difference between postoperative threshold and preoperative threshold for each frequency. The association of age, gender, tested frequency, and surgery type with hearing threshold shift was investigated with analysis of covariance. A total of 102 patients (40.8%) had a 10-dB or greater worsening of their hearing in at least one frequency on their postoperative audiogram in the contralateral, unoperated ear. One hundred six subjects (42.4%) had no change in hearing of 10 dB or greater at any frequency. Among patients with longitudinal postoperative audiograms, accelerated age-related hearing loss was observed in low frequencies. A significant number of patients demonstrated poorer hearing thresholds in the contralateral, unoperated ear after otologic and skull base surgery.

Feasibility of simultaneous meningioma resection and cesarean section: A systematic review and a technical case presentation

Feasibility of simultaneous meningioma resection and cesarean section: A systematic review and a technical case presentation

Delayed-Onset Surgical Site Infection after Sphenoid Wing Meningioma Resection: A Case Report Highlighting Diagnostic and Management Challenges

Background: Surgical site infections (SSIs) following craniotomy, while uncommon, pose significant risks. Delayed-onset infections can present diagnostic and management challenges. We report a case of delayed-onset SSI after sphenoid wing meningioma resection, emphasizing the importance of vigilance and prompt intervention. Case presentation: A 26-year-old male underwent craniotomy for a right sphenoid wing meningioma. He presented 13 days post-operatively with a fluctuant swelling at the surgical site. Imaging revealed a subgaleal and epidural abscess. He underwent craniectomy, debridement, and antibiotic therapy, resulting in complete resolution. Conclusion: Delayed-onset SSIs after craniotomy necessitate a high index of suspicion. Early diagnosis and aggressive management, including surgical debridement and appropriate antibiotics, are crucial for optimal outcomes.