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Gendreau JL, Kuo CC, Patel NA, Brown NJ, Pennington Z, Bui NE, Reardon T, Lien BV, Prevedello DM, Kuan EC, Hsu FP, Mohyeldin A. Staged Resection of Difficult-to-Treat Intracranial Meningiomas: A Systematic Review of the Indications, Surgical Approaches, and Postoperative Outcomes. J Neurol Surg B Skull Base 2024; 85:131-144. [PMID: 38449578 PMCID: PMC10914469 DOI: 10.1055/a-2015-8238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
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.
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Affiliation(s)
- Julian L. Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, United States
| | - Cathleen C. Kuo
- Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, United States
| | - Neal A. Patel
- School of Medicine, Mercer University School of Medicine, Savannah, Georgia, United States
| | - Nolan J. Brown
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
| | - Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Nicholas E. Bui
- Loma Linda University School of Medicine, Loma Linda, California, United States
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, United States
| | - Brian V. Lien
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
| | - Daniel M. Prevedello
- Department of Neurosurgery, The Ohio State University, Columbus, Ohio, United States
| | - Edward C. Kuan
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
- Department of Otolaryngology, University of California, Irvine, Orange, California, United States
| | - Frank P.K. Hsu
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
| | - Ahmed Mohyeldin
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
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Davidson L, Fishback D, Russin JJ, Weiss MH, Yu C, Pagnini PG, Zelman V, Apuzzo MLJ, Giannotta SL. Postoperative Gamma Knife surgery for benign meningiomas of the cranial base. Neurosurg Focus 2007; 23:E6. [PMID: 17961043 DOI: 10.3171/foc-07/10/e6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The standard treatment for meningiomas is complete resection, but the proximity of skull base meningiomas to important neurovascular structures makes complete excision of the lesion difficult or impossible. The authors analyzed the mid- and long-term results obtained in patients treated with postresection Gamma Knife surgery (GKS) for residual or recurrent benign meningiomas of the cranial base. METHODS Thirty-six patients with residual or recurrent benign meningiomas of the skull base following one or more surgical procedures underwent GKS. There were 31 women and five men, ranging in age from 22 to 73 years. The median tumor volume was 4.1 ml (range 0.8-20 ml) and the median radiation dose to the tumor margin was 16 Gy (range 15-16 Gy). RESULTS Patients were followed for a median of 81 months (range 30-141 months) after GKS. At the end of the follow-up period, overall neurological improvement was observed in 16 patients (44.4%), whereas the condition in 20 patients (55.6%) was unchanged. One patient suffered transient cerebral edema 6 months after GKS. Based on imaging documentation, a partial response was seen in five patients (13.9%), the disease remained stable in 30 patients (83.3%), and in one patient (2.8%) there was an increase in tumor size. The actuarial progression-free survival rate was 100% at 5 years and 94.7% at 10 years. CONCLUSIONS Gamma Knife surgery was shown to be an excellent adjunct to resection because of its durable rate of tumor control and low toxicity. It should be initially considered along with surgery for the treatment of complex skull base meningiomas.
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Affiliation(s)
- Laurence Davidson
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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