Surgery on giant meningiomas in very old patients entails frequent postoperative intracranial hemorrhages and atypical histopathology

Purpose Surgical resection of intracranial meningiomas in patients that are 80 years old and older, i.e. very old patients, is increasingly considered. Meningiomas with a largest diameter of at least 5 cm—‘giant meningiomas’—form a distinct entity, and their surgical resection is considered more difficult and prone to complications. Here, we evaluated functional outcome, morbidity and mortality, and the prognostic value of tumor size in very old patients who underwent resection of giant supratentorial meningiomas. Methods We retrospectively reviewed clinical and radiological data, functional performance (Karnofsky Performance Score), histopathological diagnosis and complications of very old patients who underwent surgery of a supratentorial meningioma at the Helsinki University Hospital between 2010 and 2018. Results We identified 76 very old patients, including 28 with a giant meningioma. Patients with a giant meningioma suffered from major complications more commonly than those with a non-giant meningioma (36% vs. 17%, p = 0.06), particularly from postoperative intracranial hemorrhages (ICH). At the 1-year follow-up, functional performance and mortality rate were comparable between patients with giant meningiomas and those with non-giant meningiomas. An exceptionally high rate of giant meningiomas were diagnosed as atypical meningiomas (WHO II) at an (11 out of 28 cases). Conclusions Giant meningioma surgery entails a high complication rate in frail, very old patients. The prevention of postoperative ICH in this specific patient group is of utmost importance. An atypical histopathology was notably frequent among very old patients with a giant meningioma, which should be taken into account when planning the surgical strategy.

DIFFICULTIES IN THE MANAGEMENT OF LARGE ASYMPTOMATIC PITUITARY ADENOMA, DETECTED DURING DIAGNOSTIC OF THE CENTRAL GYRUS REGION MENINGIOMA

Multiple intracranial tumors with different histological types diagnosed in the same patient are rare. The combination of meningiomas and pituitary adenomas in most cases concerns patients who received radiation therapy for pituitary adenomas. In our observation, the giant meningioma of the central gyrus area and large asymptomatic pituitary adenoma were diagnosed. As a result of surgical treatment performed in 2 stages, the total removal of the large pituitary adenoma was not achieved, which raised the question of finding alternative non-surgical methods of patient management. According to the results of an additional immunohistochemical study, the presence of somatostatin receptors 2a (SSTR2a) was revealed both in the pituitary adenoma and in the meningioma, which makes it possible to consider the issue of further treatment of pituitary adenoma with somatostatin receptor agonists and might reduce the risk of relapse and meningioma in the patient. Keywords: Meningioma, pituitary adenoma , multiple intracranial tumors, asymptomatic macroadenoma, somatostatin receptors.

Vision salvage after resection of a giant meningioma in a patient with a loss in light perception

Clinical approaches to the surgical management of optic chiasm compression stress quick action, as several case series have demonstrated minimal vision restoration following aggressive decompression in patients presenting more than 3 days after the onset of blindness. The authors here report the case of a 48-year-old woman who presented with near-complete binocular vision loss but regained visual function following surgical removal of a giant planum-tuberculum meningioma, which was performed 8 days after a documented loss in light perception. The interval between the patient's vision loss and successful vision-restoring decompressive surgery is the longest recorded to date in the literature. This case shows the importance of aggressive decompression of mass lesions despite extended intervals of optic nerve dysfunction.