Cranial Nerve Outcomes After Surgery for Frontal Skull Base Meningiomas: The Eternal Quest of the Maximum-Safe Resection with the Lowest Morbidity.

Maximal aggressive meningioma resection has been suggested to provide the best tumor control rates. However, radical surgery of meningiomas located at the frontal skull base can be accompanied by impairment of adjacent cranial nerve function that negatively affects patients' quality of life. We, therefore, analyzed our institutional database for cases of new cranial nerve deficits and postoperative cerebrospinal fluid (CSF) leakage stratified by the extent of tumor resection. From February 2009 to April 2017, 195 patients underwent resection of frontal skull base meningioma at our institution. Postoperative new deficits of cranial nerve function and CSF leakage were stratified by the resection into Simpson grade I resection with excision of the dural tail as an aggressive surgical approach and Simpson grade II-V resection. Simpson grade I resection was associated with a significantly greater percentage of new cranial nerve deficits immediately after surgery (30%) compared with Simpson grade II (13%; P = 0.007) and Simpson grade II-V (17%; P = 0.035). The differences were greater at the 12-month follow-up point (29% Simpson grade I, 6% Simpson grade II [P < 0.001]; 10% Simpson grade II-V [P = 0.001]). Postoperative CSF leakage occurred in 10.1% of Simpson grade I versus 2.3% of Simpson grade II resections (P = 0.048). The retreatment rates did not differ between these 2 groups (2.5% vs. 3.4%; P = 1.000). We found high levels of new cranial nerve morbidity and CSF leakage after radical removal of frontal skull base meningiomas that included the adjacent dura. Thus, less aggressive surgery for frontobasal meningioma should be preferred.

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