Neuropsychological Outcomes After Resection of Giant Anterior Skull Base Meningiomas via an Extended Bifrontal Approach
Pablo Recinos, Richard Naugle, Varun Kshettry, Alankrita Raghavan, Hamid Borghei-Razavi
Introduction: Giant anterior skull base meningiomas often present with changes in mental status and executive function. With 5-year survival of patients with benign meningiomas exceeding 90%, interrogating quality-of-life parameters such as neuropsychological function has become of increasing interest.
Objective: We examined pre- and postoperative neuropsychological results in patients who underwent resection of giant anterior skull base meningiomas via an extended bifrontal approach.
Methods: A retrospective review was performed of patients who underwent extended bifrontal craniotomies for meningiomas at our institution between 2016-2019. Cognitive function, including verbal memory and visuospatial reasoning, was evaluated with formal neuropsychological testing before and/or after surgery. Brain edema was quantified by the maximum diameter of FLAIR/T2 abnormalities in pre- and postoperative MRI scans.
Results: Sixteen patients met inclusion criteria. All patients had tumors with a diameter greater than 3 cm, with average maximum tumor diameter being 5.78 cm. There were three postoperative complications of CSF leak and no perioperative stroke or mortality. There was no significant change in pre- and postoperative edema. Nine of eleven neuropsychological parameters improved postoperatively, with processing speed improving significantly (standard score: 69.5 vs. 81.8, p = 0.039).
Conclusions: Postoperative neuropsychological test scores largely improved in our series. Routine neuropsychological testing in patients with anterior skull base meningiomas can not only help provide information regarding postoperative cognitive changes, it may also be an essential step in helping patients return to their personal and professional lives after tumor resection. Based on these results, we propose a short battery of neuropsychological tests to query frontal lobe functions in patients with anterior fossa meningiomas.