Giant and Large Anterior Clinoid Meningiomas Encasing Major Arteries: Single-Center Experience and Literature Review

Abstract The aim of this study was to evaluate postoperative and long-term outcomes in patients undergoing anterior clinoid process (ACP) meningioma resection complicated by vascular injury. Retrospective observational cohort study combined with a nonsystematic literature review. This study was conducted at a tertiary academic medical center. We retrospectively analyzed a consecutive clinical series and conducted a nonsystematic literature review. Thirteen patients were included. The mean age was 62.1 years, the mean tumor volume was 307.3 cm3, and the mean follow-up was 54.3 months. The internal carotid artery was involved in all cases, with complete circumferential encasement in 50%. GTR was achieved in all patients. Postoperatively, three patients developed hemiparesis and one developed left hemiplegia. Two patients experienced ischemic stroke, one of whom was treated with middle cerebral artery stenting. At final follow-up, all patients demonstrated neurological improvement, with a mean Karnofsky Performance Status of 92.5. The review included 27 studies encompassing 691 patients. Vascular complications were reported in 44 cases (6.4%). Direct intraoperative arterial injury was the predominant mechanism (77%), while severe vasospasm accounted for 23%. Postoperative hemiparesis occurred in 16 patients (36.4%). One case of persistent hemiplegia was reported at long-term follow-up, and seven deaths were documented. ACP meningiomas encasing major arteries are associated with a significant risk of severe vascular complications. Vasospasm and direct arterial injury may result in devastating ischemic stroke. Further studies are required to define optimal management strategies and clarify the prognostic impact of vascular complications on long-term outcomes.