ArticleNeurosurgical review2025
Comparative outcomes of giant versus non-giant anterior clinoidal meningiomas: A single-center case series with extended follow-up.
Article in Neurosurgical review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Anterior clinoidal meningiomas (ACMs) are complex skull base tumors that may pose significant surgical challenges due to their proximity to critical neurovascular structures. While tumor size is often assumed to correlate with worse outcomes, comparative data between giant (≥5 cm) and non-giant (<5 cm) ACMs remain limited. Objective: To compare clinical presentation, radiological features, surgical strategy, and functional outcomes between giant and non-giant ACMs. A retrospective analysis of 47 patients who underwent surgical resection of ACMs between 2014 and 2023. Patients were stratified into non-giant (<5 cm, n = 36) and giant (≥5 cm, n = 11) groups. Variables included demographics, imaging findings, Al-Mefty classification, vascular encasement, extent of resection, postoperative complications, and long-term outcomes. The primary surgical approach was pterional craniotomy with frequent extradural clinoidectomy. Visual impairment was more frequent in non-giant ACMs (36.1%) compared to giant (18.1%). Vascular encasement, particularly of the internal carotid artery, was significantly higher in the giant group (91% vs 53%; p = 0.009). Cavernous sinus involvement was paradoxically more common in non-giant tumors (25% vs 18.1%). Gross total resection (Simpson grade I-II) was achieved in 78% of non-giant and 73% of giant tumors. Visual improvement occurred in 11.1% of patients, and all new postoperative visual deficits recovered during follow-up. Mean follow-up was 34.2 ± 30.3 months (non-giant) and 26.7 ± 34.7 months (giant). Most patients achieved a favorable functional outcome (mRS ≤ 1). Giant ACMs are associated with greater vascular encasement and longer operative time, but not necessarily worse visual or functional outcomes. Tumor size alone is not a reliable predictor of cavernous sinus invasion or postoperative vision. These findings support the need for individualized surgical strategies based on anatomy rather than size alone.
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