Resident Houston Methodist Hospital Houston, Texas, United States
Introduction: Surgery for giant intracranial masses is more difficult with higher complication and mortality rates. Many are multicompartment, involve neurovascular structures, and have edema or brainstem compression. The ideal strategy for their resection remains unknown in the literature. Here we describe the outcomes of giant intracranial tumors that were performed in a planned staged manner by the senior author in a single institution.
Methods: A retrospective chart review from 2013-2022 was performed for patients with intracranial masses resected in a staged manner. Patients with multiple cranial surgeries due to recurrence or anesthetic complications were excluded. The patients’ demographics and >6mo outcomes are described. Tumor characteristics, location, approaches, and complications are described.
Results: 25 patients were identified with planned staged surgeries consisting of 3 vestibular schwannomas, 2 sellar masses, one craniocervical schwannoma and one chondrosarcoma. There were 18 meningiomas: 8 petroclival, 5 anterior fossa, 2 sphenoid wing, 2 foramen magnum, and 1 at the convexity. Average patient age was 49.9 years STD: 15.25. The average volume of vestibular schwannomas was 30.89 cm^3 STD: 4.14. Average petroclival meningioma volume was smaller than all other staged meningiomas, but this result was not significant (28.41 cm^3 STD: 21.12 vs 53.08 cm^3 STD: 39.98 p=0.156). There were no mortalities. All patients had mRS of 0-1 at 6mo follow up, except for two patients who remained at baseline. New cranial nerve palsies were present in 5 patients. Complications occurred in two patients who sustained a DVT or wound infection. 48% were gross-total or near-total resection, 32% were subtotal resection, and 15% were partial resections. The average time to next stagey was 63.83 days STD: 66.09.
Conclusion : Staged surgery is a safe alternative option to single stage surgery. For this cohort, petroclival meningiomas had a lower threshold in size to be considered for staged surgery, although this was not significant.
