Comparative Outcomes of Frontal, Bifrontal, and Pterional Craniotomies for Resection of Large Anterior Skull Base Meningiomas.

BACKGROUND AND

OBJECTIVES

Large anterior skull base meningiomas are common and challenging brain tumors to resect. This study evaluates the role of the frontal, bifrontal, and pterional craniotomies on outcomes after resection.

METHODS

This is a retrospective study of patients with large anterior skull base operated on at our institution between 2010 and 2024 using the frontal, bifrontal, and pterional approaches. All patients were 18 years or older and had ≥1 year of clinical follow-up data. Propensity-score matching (PSM) with a one-to-many nearest neighbor matching algorithm was used to achieve 3 groups of similar patients, based on size, grade, and preoperative Karnofsky Performance Status. The Shapiro-Wilk test, paired T -test, analysis of variance, and Tukey test were used to establish statistical significance. Pearson R was used to evaluate PSM success, with the log-rank test used within Kaplan-Meier analysis and multiple-linear regressions performed to evaluate predictors of outcomes.

RESULTS

In total, 337 patients (140M, 197F) were included, with 80, 189, and 68 patients undergoing bifrontal, frontal, and pterional craniotomies, respectively. Patients in the bifrontal group presented with significantly higher tumor size (5.46 cm, P = .0021) and lower mean preoperative Karnofsky Performance Status (71.15, P = .0059), while patients in the frontal group reported a significantly higher tumor grade vs other groups (1.65, P = .0025). After PSM, the bifrontal group reported a significantly higher frequency of medical (25.0%, P < .0001) and surgical (22.5%, P < .0001) complications, alongside significantly worse cosmetic outcomes (6.25%, P = .0054) vs other groups. Kaplan-Meier analysis showed a significantly higher rate of minor complications in the bifrontal group ( P = .0497), alongside reduced progression-free survival in the frontal group ( P = .0048). Regression analyses revealed olfactory groove meningiomas and subtotal resections predicted worse outcomes for the pterional and frontal approaches, respectively.

CONCLUSION

The findings suggest significant difference in baseline characteristics and operative outcomes across the 3 groups, highlighting predictive factors and risk profiles that neurosurgeons can include in perioperative planning.