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Published on: July 5, 2021
The relation between surgical cleavage and preoperative neuroradiological findings in intracranial meningiomas
Erhan Celikoglu1, Hikmet Turan Suslu, Julide Hazneci
1Neurosurgery Clinic, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Petrol Is Mahallesi, Raman Sokak, Kartal, Istanbul, Turkey.
Background:
Meningiomas are generally benign masses, and in many cases they do not invade the brain. Therefore their potential to provide cures is high. The most important cause of the development of recurrence in the post-operative period is subtotal resection. Any information that will allow us to perform total mass resection will be beneficial in terms of long-term good clinical procedure. Our aim in this study is to obtain the radiological data from which we can obtain accurate information in terms of the surgical cleavage between the tumor and parenchyma during the surgical planning of the meningiomas.
Methods:
We evaluated 85 cases with intracranial meningioma that were treated by the same microsurgical technique. All posterior fossa and skull base meningiomas were not included in the study.
Results:
Tumor size was smaller than 3 cm in 19 cases, between 3 and 6 cm in 46 cases, and bigger than 6 cm in 20 cases. The cleavage line between the tumor capsule and the cortex underneath was extrapial in 32 cases, subpial in 29 cases, and mixed in 24 cases. Dominant arterial supply was dural in 46 cases. Thirty-three cases were predominantly mixed and 6 cases were predominantly corticopial. At magnetic resonance images, 16 of 28 cases which showed clear tumor-cortex interface, had an extrapial cleavage line.
Conclusions:
When surgical treatment of intracranial meningiomas are considered, it is necessary to examine if there is a surgically safe border between the cortex underneath in the preoperative images. It can be concluded that it is appropriate to operate small meningiomas which are on the sensitive regions of the brain when they are in their earlier stages and still have an extrapial cleavage.
Insights
Identifying the surgical cleavage plane in meningiomas preoperatively is key to achieving total resection and preventing recurrence. Preoperative imaging can reveal an extrapial cleavage, aiding in surgical planning for better outcomes.
Area of Science:
- Neurosurgery
- Radiology
- Oncology
Background:
- Meningiomas are typically benign brain tumors with high cure potential.
- Subtotal resection is a primary cause of postoperative recurrence.
- Accurate surgical planning is crucial for complete tumor removal.
Purpose of the Study:
- To identify radiological data for assessing the surgical cleavage plane between meningiomas and brain parenchyma.
- To improve preoperative surgical planning for intracranial meningiomas.
Main Methods:
- Evaluation of 85 intracranial meningioma cases treated with microsurgery.
- Exclusion of posterior fossa and skull base meningiomas.
- Analysis of tumor size, cleavage plane, and arterial supply.
Main Results:
- Tumor sizes ranged from <3 cm to >6 cm.
- Cleavage planes were extrapial, subpial, or mixed.
- Extrapial cleavage was observed in 16 of 28 cases with a clear tumor-cortex interface on MRI.
Conclusions:
- Preoperative assessment of the surgical cleavage plane is essential for intracranial meningioma surgery.
- Early-stage meningiomas with extrapial cleavage in sensitive brain regions are suitable for surgical intervention.
