Intracranial meningioma surgery

• Predicting intraoperative meningioma consistency using features from standard MRI sequences: a preoperative evaluation
• The dural tail in intracranial meningioma: Heads up or tail down? A systematic review of the literature
• Simultaneous surgical management of a giant tuberculum sellae meningioma and pregnancy-related complications: a case report and literature review
• Management of skull base meningiomas with extracranial extension: resection, recurrence, and prognostic factors
• Impact of tumor size and peritumoral edema on outcomes and complications in anterior midline skull base meningiomas
• Solitary brain metastasis mimicking meningioma as the initial presentation of concurrent pulmonary and breast sarcomatoid carcinoma in a male patient: A rare entity with literature review
• Risk factors for postoperative thrombotic complications after meningioma resection: a retrospective single-center study in China
• Surgical Management of a Painful Temporal Bone En Plaque Meningioma: A Case Report and Review of the Literature

Meningiomas are often very bloody. Preoperative embolization and autologous blood donation may be helpful for specific tumors. General principles of meningioma surgery:

1. early interruption of the blood supply to the tumor

2. internal decompression (using ultrasonic aspirator, cautery loops…)

3. dissection of the tumor capsule from the brain by cutting and coagulating vascular and arachnoid attachments while infolding the tumor into the area of decompression with minimal retraction on adjacent brain

4. removal of attached bone and dura when possible.

Intracranial Meningioma Surgery Indications.

Preoperative embolization of intracranial meningioma.

As usual, the head should be elevated ≈ 30° above the right atrium.

For meningiomas involving the superior sagittal sinus (SSS):

● for tumors involving the anterior third of the SSS: supine semi-sitting position

● for tumors of the middle third of the SSS: lateral position with the side of the tumor down, the neck tilted 45° toward the upward shoulder

● for tumors of the posterior third of the SSS: prone position.

Attempting to occlude or bypass the middle third of the superior sagittal sinus involved with meningioma is treacherous. Even in expert hands, there is significant risk of venous infarction/sinus occlusion with 8% morbidity and 3% mortality, and complete removal is still not assured. Venous drainage may occur through the dura adjacent to the sinus, in the skin, bone of the skull and even the tumor itself may participate. It is almost always preferable to leave residual tumor and consider treating it with radiation therapy than to precipitate venous infarction.

Meningioma surgery - Are we making progress? ¹⁾.

Main goal of meningioma surgery is to obtain the complete tumor resection in order to reduce the recurrence rate but preserving or improving the patient's neurological functions ²⁾

In many cases this is a difficult achievement, because of the risk of damages to arteries, sinuses, cranial nerves or other neighbors relevant structures. Surgical morbidity and mortality are mainly related to tumor location and volume ³⁾.

see Intraoperative ultrasound in intracranial meningioma.

see 5-aminolevulinic acid fluorescence guided resection of intracranial meningioma.

Duraplasty using a nonsutured graft and sutured dural repair exhibit similar postoperative outcomes for patients undergoing supratentorial meningioma surgerys. Although dural sutured grafts may sometimes be necessary, nonsutured graft reconstruction for most supratentorial meningioma resections may suffice. The decreased operative time associated with nonsutured grafts may ultimately result in cost savings. These findings should be taken into consideration when selecting a dural reconstruction technique for supratentorial meningioma ⁴⁾

see Intracranial meningioma surgery outcome.

Intracranial meningioma surgery complications