Two-Staged Approach for Giant Hypervascular Meningioma Resection

INTRODUCTION: Giant meningiomas represent very uncommon and challenging tumors. Surgical morbidity is high due to the difficult and complex approaches to devascularize these hypervascular lesions. In the present series, we demonstrate a two-staged approach for surgical resection of giant hypervascular meningiomas. PATIENTS AND METHODS: Four such patients having giant hypervascular meningiomas between July 2017 and June 2019 were taken in the present study. There were two falco-tentorial, one anterior and middle parasagittal and falcine meningioma, and one sphenoid wing with convexity meningioma. RESULTS: In the first stage, only the hypervascular bone was removed, and the dura was coagulated and excised. In the definitive stage, usually undertaken 5–8 days following the first surgery, the meningioma was excised, leading to Simpson's Grade 2 excision in two and Grade 3 excision in the remaining two patients. There was one mortality of a previously operated malignant meningioma (histopathologically proven), owing to a cardiac event in the patient, while the other three were discharged without any new neurologic deficit. CONCLUSION: Two-staged approach for giant meningiomas represents a safe and effective surgical management, tolerable for the patient and more comfortable for the neurosurgeon.