# Optimizing Surgical Management of Anterior Skull Base Meningiomas: Imaging Modalities, Key Surgical Considerations, and Risk Mitigation Strategies

## TL;DR

This review discusses how to improve surgery for anterior skull base meningiomas by focusing on imaging, surgical factors, and risk reduction.

## Contribution

The paper provides a comprehensive review of surgical considerations and imaging strategies for managing anterior skull base meningiomas.

## Key findings

- Surgical outcomes depend on factors like arachnoid plane integrity, tumor size, and vascular encasement.
- Effective imaging is crucial for evaluating tumor characteristics and guiding surgical decisions.
- Optimizing imaging and surgical strategies can reduce complications and improve recovery.

## Abstract

Skull base meningiomas pose significant surgical challenges due to their proximity to vital neurovascular structures. Key factors influencing surgical outcomes include the integrity of the arachnoid plane, tumor size and consistency, brain edema, nerve involvement, vascular encasement, and invasion of critical areas. These factors affect the feasibility of complete tumor removal and postoperative recovery. This review explores critical surgical considerations, effective imaging techniques for evaluation, and strategies to optimize decision-making, reduce risks, and minimize complications.

Skull base meningiomas present considerable challenges in surgical management due to their proximity to critical neurovascular structures. Anterior skull base meningiomas encompass olfactory groove, supra- and parasellar, anterior sphenoid ridge, cavernous sinus, and spheno-orbital tumors. The success of surgical resection and the likelihood of complications are influenced by several key factors, including the presence of an intact arachnoid plane, tumor size and consistency, peritumoral brain edema, cranial nerve involvement, vascular encasement, and invasion of critical areas such as the optic canal or cavernous sinus. These factors not only affect the feasibility of gross total resection but also play a pivotal role in determining functional outcomes and postoperative recovery. With the vast array of imaging modalities available, selecting the most appropriate investigations to assess these parameters and tailoring surgical strategies accordingly remain complex tasks. This review examines the critical surgical parameters, identifies the most effective imaging modalities for evaluating each, and provides key insights into how this analysis can guide surgical decision-making, mitigate risks, and minimize complications.