Abstract
This study aims to describe the impact of tumor size and peritumoral edema in anterior midline skull base meningiomas on clinical outcome. Patients with these meningiomas undergoing resection between 2012 and 2022 were included. Meningiomas were divided into three groups by size and edema. The primary outcome was the Karnofsky Performance Scale (KPS) score at three months post-surgery. Preoperative KPS, KPS at discharge, KPS at last follow-up and complication rates were analyzed. Outcomes for large meningiomas (> 50 mm) were significantly worse at discharge (KPS 50%) compared to medium-sized (30–50 mm; KPS 70%) and small tumors (< 30 mm; KPS 80%; p < 0.0001). KPS at three months showed persisting significant differences: small (KPS 90%), medium-sized (KPS 85%), and large tumors (KPS 80%; p = 0.0209). KPS at discharge in large tumors was significantly dependent on edema: KPS 90% in large tumors without edema, KPS 70% with moderate edema, and KPS 50% with extensive edema (p = 0.0008). Complication rate was 28%, with 14% for small, and 35–37% for medium-sized and large meningiomas (p = 0.0613). Complication rate was higher in tumors with peritumoral edema (35%) compared to tumors without edema (23%; p = 0.2051). The outcome and complication rates suggest higher surgical risk for larger tumors with marked peritumoral edema. Surgical strategies may need to adapt to these risk factors.