Staged Open Cranial Surgery for Primary Intra-axial Neoplasms: A Systematic Review

Introduction: Staged surgery for skull base lesions has been utilized to facilitate maximal safe resection and optimize outcomes while minimizing morbidity and complications. Conversely, staged surgery for primary intraparenchymal neoplasms is less commonly performed and has not been reported as extensively within the literature. As such, we performed a systematic review to examine the unique surgical indications for staging, timing between stages, specific surgical approaches employed, and postoperative complications of staged surgery for primary intra-axial neoplasms.

Methods: A literature search was conducted using PubMed, Web of Science, and Cochrane databases using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. Titles and abstracts were evaluated independently by two authors, after which articles were selected for final analysis based on application of strict inclusion criteria during full text screen. Each included article was then qualitatively assessed and relevant variables, including operative approaches, timing, and outcomes, were extracted for synthesis.

Results: Of 115 results, 10 articles were included for analysis and consisted of 18 pediatric and 4 adult patients. Staged approaches were more commonly utilized in the pediatric population for resection of astrocytoma and glioma. Pediatric patients had timing of surgeries ranging from 5 days to several weeks between operations, compared to between 18 days and 4 months in adult patients. Complications in pediatric patients were most commonly hemiparesis and homonymous hemianopsia, hydrocephalus, CN VI and VII palsies, truncal ataxia, and cerebellar mutism, while complications in adult patients included language and abstract thinking deficits, respiratory failure, and motor weakness.

Conclusion : This study reports the first comprehensive review of staged surgical procedures for primary, intra-axial cranial neoplasms. There exists a large degree of heterogeneity in complications resulting from staged surgeries for intra-axial neoplasms, which are similar to complications associated with single-stage surgery for intraparenchymal lesions as well as multi-stage surgeries for skull base lesions.