gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Size does matter! Treatment of giant intracranial and extracranial meningiomas

Meeting Abstract

  • M. Oertel - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen
  • Y.-M. Ryang - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen
  • J. Gilsbach - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen
  • M. Korinth - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.11-06

doi: 10.3205/09dgnc076, urn:nbn:de:0183-09dgnc0763

Published: May 20, 2009

© 2009 Oertel et al.
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Outline

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Objective: Giant intracranial and extracranial meningioma (GIEM) is an exceptional and surgically demanding pathologic entity. In the present study our experience in the management of large primary extradural meningioma arising inside and outside the intracranial compartment is described.

Methods: The data of 8 consecutive patients (5 males, 3 females) microsurgically treated for GIEM between 1994 and 2008 was retrospectively analysed. The mean age was 52 years (range 22 to 71 years). All patients presented with extracranial swelling. 4/8 patients suffered from headache, 2/8 patients complained of each seizures and dizziness, and 1 patient presented with impaired vision. GIEM location included: 4/8 frontal, 2/8 frontoparietal, 1/8 parietal, and 1/8 parietooccipital. Microsurgical tumour resection with acrylic-augmented cranioplasty was performed in all cases. Two stage surgical excision with removal of only the extracranial component at the first operation was undertaken in 2/8 patients. 7/8 patients received dural repair with autologous (3/7) or synthetic (4/7) patch graft. Adjuvant postoperative percutaneous radiotherapy was applied in 1 patient.

Results: In our series complete removal of GIEM was achieved in 5/8 patients. Surgery-associated complications included: 6/8 CSF leaks, 3/8 wound healing disturbances, 2/8 venous engorgement, and 2/8 postoperative haematomas, altogether requiring reoperation in 3/8 cases. Histopathological examination revealed meningothelial (6/8) or atypical (2/8) GIEM. While half of the patients deteriorated or improved after surgery, 7/8 patients exhibited persistent symptom improvement during long-term follow-up postoperatively. 1 patient died of pulmonary embolism.

Conclusions: The management of GIEM represents a surgical challenge, carries a high risk of morbidity caused by various possible types of complications, and demands special treatment due to the large tumour size and involvement of scalp, calvaria, meninges, brain parenchyma, and vascular structures. The treatment of choice is partial or complete microsurgical resection with simultaneous cranioplasty frequently accompanied by dural graft whereas staging of surgical resection represents a helpful alternative operative option. Nevertheless, excellent postoperative long-term clinical outcome can be expected in the vast majority of patients.