Single-stage versus two-stage resection for large anterior midline skull base meningiomas with bihemispheric peritumoral edema
Lina-Elisabeth Qasem (Frankfurt a. M.), Ali Al-Hilou (Frankfurt a. M.), Vincent Prinz (Frankfurt a. M.), Daniel Jussen (Frankfurt a. M.), Gerhard Marquardt (Frankfurt a. M.), Marcus Czabanka (Frankfurt a. M.)
Microsurgical resection of large midline meningiomas of the anterior skull base with bihemispheric peritumoral edema is characterized by an increased risk profile due neurovascular conflicts and postoperative edema decompensation leading to increased intracranial pressure. Craniectomy allows treatment of intracranial pressure but requires secondary cranioplasty. The aim was to compare a single-stage osteoplastic craniotomy followed by microsurgical tumor resection with a two-stage approach using bifrontal craniectomy, tumor resection, and subsequent cranioplasty after edema recovery.
Patients with anterior midline skull base meningiomas were included in the study. All patients underwent microsurgical resection. The final analysis included patients with large tumors (diameter > 50 mm) and bihemispheric peritumoral edema greater than the tumor diameter. Group 1 patients underwent single-stage tumor resection with osteoplastic craniotomy and served as the historical control. Group 2 patients were treated with a two-stage approach of bifrontal craniectomy, tumor resection, and subsequent cranioplasty in a second surgical step and were collected in a prospective series. All data were analyzed retrospectively. The primary outcome measure was the Karnofsky Performance Scale (KPS) at 3 months after surgery. Preoperative KPS, KPS at discharge and at last date seen, as well as intensive care unit (ICU) stay, elective mechanical ventilation, length of hospital stay, and complication rate were also analyzed. Statistical comparisons were made using the Mann-Whitney u test.
There were no differences in baseline patient characteristics, including mean age, tumor size, and extent of peritumoral edema. KPS at 3 months after surgery was significantly improved in Group 2 (73% vs. 49%; p=0.0288) with a non-significant reduction in ICU stay (8 vs. 10 days; p=0.9001). The length of hospital stay was not significantly longer in Group 2 patients (24 vs. 17 days; p=0.1916). The complication rate was comparable between Group 1 and Group 2 patients (67% vs. 56%; p=0.6274).
Two-stage resection of large anterior midline skull base meningiomas with significant peritumoral edema demonstrates improved clinical outcomes compared to a historical single-stage resection control group in a highly selected patient population and non-randomized study design.
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