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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(04): 715-720
DOI: 10.1055/s-0044-1790514
Original Article

Emergency Surgical Management of Meningiomas: Factors Affecting Early Outcomes and Complications

Gaurav Tyagi
1   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Mustafa Iqbal Chandshah
2   Department of Neurosurgery, Rahaman Hospital, Guwahati, Assam, India
,
Gyani Jail Singh Birua
3   Department of Neuroanesthesia, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Nishanth Sadashiva 
1   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Subhas Konar
1   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Manish Beniwal
1   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
A.R. Prabhuraj
1   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
T. S. Lingaraju
1   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Gopal Krishna
3   Department of Neuroanesthesia, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Nupur Pruthi
1   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Dhaval P. Shukla 
1   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Abstract

Objective Intracranial meningiomas constitute a third of all brain tumors and are among the most common indications for neurosurgical procedures performed worldwide. Most meningiomas present with an indolent, longstanding history. However, the data on outcomes of emergency surgeries for meningioma is limited. This study aims to present our experience of urgent surgical intervention in patients with meningiomas presenting acutely. We also analyze the factors influencing early neurological outcomes and complications.

Materials and Methods All nonelective meningioma surgeries done on an emergency basis between January 2015 and December 2019 were retrospectively reviewed. Patients' demography, clinical, and radiological details were recorded for analysis. The surgical procedure, complications, and follow-up outcomes were also included for statistical comparison.

Results Forty-four patients qualified for the study with a mean age of 49.4 ± 13.4 years. The average presenting Glasgow Coma Scale (GCS) was 13; 47.7% of cases presented with altered sensorium. The most common lesion location was convexity (25, 56.8%), and the mean tumor volume was 74.1 ± 36.5 mL. Gross peritumor edema with mass effect was seen in 16 patients (36.4%). The mean Karnofsky Performance Status at 3 months' follow-up was 89.3 ± 18.2. Patient age and tumor size did not affect outcomes. The presenting GCS of < 15 (odds ratio [OR] 8.8, confidence interval [CI] 0.95–80.72, p 0.03) and the occurrence of postoperative complications (OR 25.71, CI 2.65–249.2, p 0.001) were associated with unfavorable outcomes. Although not statistically significant, a poor tumor grade was also associated with worse clinical outcomes (p 0.20).

Conclusion Emergency meningioma surgery has comparable outcomes and complication rates with routine elective procedures. Grade II/III meningiomas are more likely to present with acute neurological deterioration and carry a relatively worse prognosis. Poor presenting GCS and postoperative complications are the most critical factors associated with poor patient outcomes in our study.

Keywords

emergency meningioma surgery - emergency neuro-oncology - meningiomas - meningioma surgery outcomes

Patients' Consent

A written informed consent was taken from the patients for using encrypted patient clinical and imaging details for research and publication purposes.




Publication History

Article published online:
30 September 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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