Case series of trigonal meningiomas

Area of Science:

• Neurosurgery
• Neuro-oncology
• Cerebral Tumor Surgery

Background:

• Trigonal meningiomas present unique clinical and surgical challenges due to their deep brain location.
• Understanding surgical nuances is critical for effective management of these tumors.

Purpose of the Study:

• To present surgical experience with trigonal meningiomas.
• To discuss effective surgical corridors and approaches for these deep-seated tumors.

Main Methods:

• Retrospective analysis of 12 trigonal meningioma cases operated over two decades.
• Review of patient demographics, clinical presentation, imaging, and surgical strategies.

Main Results:

• Mean symptom-to-presentation time was 10.4 months, with most patients presenting with non-localizing symptoms of increased intracranial pressure.
• Lesions were typically large (>6 cm), often left-sided, and the inferior temporo-parietal approach was preferred.
• Most symptoms resolved post-operatively, with homonymous hemianopia being the exception.

Conclusions:

• The "shortest route" surgical approach demonstrates a low incidence of neurological deficit, even in dominant hemispheres or eloquent areas.
• This approach may be advantageous in resource-limited settings lacking advanced neuroimaging tools like neuronavigation and tractography.
• Long-standing lesions may allow for functional reorganization, making the "shortest route" a viable surgical option.