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J Neurol Surg B Skull Base 2024; 85(02): 131-144
DOI: 10.1055/a-2015-8238
Original Article

Staged Resection of Difficult-to-Treat Intracranial Meningiomas: A Systematic Review of the Indications, Surgical Approaches, and Postoperative Outcomes

Julian L. Gendreau
1   Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, United States
,
Cathleen C. Kuo
2   Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, United States
,
Neal A. Patel
3   School of Medicine, Mercer University School of Medicine, Savannah, Georgia, United States
,
Nolan J. Brown
4   Department of Neurosurgery, University of California, Irvine, Orange, California, United States
,
Zach Pennington
5   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Nicholas E. Bui
6   Loma Linda University School of Medicine, Loma Linda, California, United States
,
Taylor Reardon
7   Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, United States
,
Brian V. Lien
4   Department of Neurosurgery, University of California, Irvine, Orange, California, United States
,
Daniel M. Prevedello
8   Department of Neurosurgery, The Ohio State University, Columbus, Ohio, United States
,
Edward C. Kuan
4   Department of Neurosurgery, University of California, Irvine, Orange, California, United States
9   Department of Otolaryngology, University of California, Irvine, Orange, California, United States
,
Frank P.K. Hsu
4   Department of Neurosurgery, University of California, Irvine, Orange, California, United States
,
Ahmed Mohyeldin
4   Department of Neurosurgery, University of California, Irvine, Orange, California, United States
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Abstract

Introduction Meningiomas—the most common extra-axial tumors—are benign, slow-growing dural-based lesions that can involve multiple cranial fossae and can progress insidiously for years until coming to clinical attention secondary to compression of adjacent neurovascular structures. For complex, multicompartmental lesions, multistaged surgeries have been increasingly shown to enhance maximal safe resection while minimizing adverse sequela. Here, we systematically review the extant literature to highlight the merits of staged resection.

Methods PubMed, Scopus, and Web of Science databases were queried to identify articles reporting resections of intracranial meningiomas using a multistaged approach, and articles were screened for possible inclusion in a systematic process performed by two authors.

Results Of 118 identified studies, 36 describing 169 patients (mean age 42.6 ± 21.3 years) met inclusion/exclusion criteria. Petroclival lesions comprised 57% of cases, with the most common indications for a multistaged approach being large size, close approximation of critical neurovascular structures, minimization of brain retraction, identification and ligation of deep vessels feeding the tumor, and resection of residual tumor found on postoperative imaging. Most second-stage surgeries occurred within 3 months of the index surgery. Few complications were reported and multistaged resections appeared to be well tolerated overall.

Conclusions Current literature suggests multistaged approaches for meningioma resection are well-tolerated. However, there is insufficient comparative evidence to draw definitive conclusions about its advantages over an unstaged approach. There are similarly insufficient data to generate an evidence-based decision-making framework for when a staged approach should be employed. This highlights the need for collaborative efforts among skull base surgeons to establish an evidentiary to support the use of staged approaches and to outline those indications that merit such an approach.

Keywords

approach - complications - extra-axial - indication - meningioma - multistaged - stage - skull base - timing

Supplementary Material



Publication History

Received: 27 August 2022

Accepted: 09 January 2023

Accepted Manuscript online:
19 January 2023

Article published online:
17 February 2023

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