Giant skull base meningiomas: Definitions, case reports, and surgical approaches

Giant skull base meningiomas are rare and surgically demanding due to proximity to critical neurovascular structures, prolonged operative time, and reduced resection rates. Reports encompassing multiple skull base regions remain limited. This case-based series includes anterior, middle, and posterior fossa tumors, emphasizing anatomical diversity and surgical strategies.

Eleven patients with giant skull base meningiomas were retrospectively reviewed, including tumors ≥5 cm and surgically complex lesions. The mean age was 47.7 years (range 32-62), with a female predominance (8 females, 3 males). Presenting symptoms included visual loss, headache, anosmia, hemiparesis, and cranial nerve deficits. Approaches were tailored to tumor location, most commonly pterional and retrosigmoid, followed by bifrontal and combined skull base craniotomies. Gross total resection was achieved in 8 of 11 patients (72.7%). Near-total or subtotal resection (3/11) was performed when tumors encased critical neurovascular structures. Visual outcomes were favorable, with recovery or preservation in most anterior and middle fossa cases. Transient cranial nerve palsies occurred in two patients and resolved on follow-up. No postoperative mortality occurred. During follow-up ranging from 4 months to 5 years, no recurrences were observed, and residual disease remained stable.

This series illustrates the anatomical spectrum and surgical complexity of giant skull base meningiomas. Favorable outcomes were achieved with individualized approaches and multidisciplinary planning. These cases contribute practical insights to the limited literature and reinforce the need for tailored management strategies.