Single-Stage Gross Total Resection of Seven Meningiomas: A Report and Discussion of Feasibility

Abstract

BACKGROUND AND IMPORTANCE: Multiple meningiomas are relatively uncommon, particularly in the sporadic, non-neurofibromatosis type 2 (NF2) setting. When numerous lesions are distributed across different intracranial compartments, surgical strategy frequently favors staged resection to limit perioperative risk. However, staged procedures carry the burden of multiple anesthetics, prolonged hospitalization, and potential interval tumor progression. The present case illustrates the feasibility of single-stage resection for 7 synchronous meningiomas. CLINICAL PRESENTATION: A 63-year-old woman presented with a 6-year history of personality change. Magnetic resonance imaging revealed 7 meningiomas located at the right infratentorial cerebellopontine angle region, bilateral frontal convexities, falx cerebri, and right cavernous sinus region, accompanied by marked bifrontal edema and midline shift. She had multiple comorbidities, including valvular heart disease with atrial fibrillation. Following multidisciplinary evaluation, she underwent a single-stage bicoronal approach for gross total resection of all lesions, along with dural repair, decompressive craniectomy, and skull base reconstruction. Postoperative course required intensive care for respiratory support, infection treatment, and intracranial pressure control. Histopathology confirmed a WHO grade I meningioma with low proliferative index (Ki-67 ∼2%) and no evidence of NF2. At 3-month follow-up after cranioplasty, the patient remained neurologically intact (GCS 15, muscle power 5/5 in all limbs) with no residual tumor. CONCLUSION: In carefully selected patients with multiple meningiomas, single-stage gross total resection is achievable with meticulous preoperative planning, appropriate exposure, and intensive perioperative care. This strategy may reduce the overall treatment burden and avoid the risks of tumor progression inherent to staged surgery.