Skull Base Meningioma Surgeries: How Aggressive Is Aggressive Enough?

Introduction: Skull base surgeons frequently sink into a dilemma while dealing with skull base meningiomas because of the involvements of crucial neurovascular structures: “Shall we be aggressive to reduce tumor recurrence rate or shall we be conservative to diminish the postoperative neurological deficits?” The present study aims to clarify the correlation between the resection rate, neurological outcomes, and clinical results in patients with skull base meningiomas.

Material and Methods: Patients who underwent surgeries for skull base meningiomas by our senior author during 2010–2018 were included. The first postoperative image would be obtained within 3 days postoperatively for evaluation of resection rates, and then followed by every 3 or 6 months, depending on the pathological grading of the tumor. Medical records and clinic data were retrospectively reviewed for statistical analyses.

Results: A total of 143 patients with a median follow-up time of 27.3 months were included. The mean resection rate is 93.4% (33.3–100%). Postoperatively, 23 patients (16%) presented with new-onset or worsen cranial nerve deficits (CNDs), of which were smelling disturbance (4%), eye symptoms (43%), facial numbness (17%), facial palsy(22%), and swallowing difficulties (13%). Fifty-seven patients (39.8%), including postoperative cranial nerve deficits, experienced postoperative complications. Main symptoms were hydrocephalus (23%), infarctions (21%), eye symptoms (18%), and infections (9%). In our series, a resection rate over 93% for Grade I meningiomas was associated with prolonged progression-free survival (p = 0.018). For Grade II or Grade III meningiomas, a resection rate over 97% was associated with prolonged progression-free survival (p = 0.031). The correlation between resection rates and postoperative CNDs or complications were not statistically significant. (p = 0.47 and 0.35)

Conclusion: Extensive resection for skull base meningioma may be encouraged under the premise that the surgeon is confident of avoiding postoperative deficits, especially while operating high-grade tumors.