Total Resection of a Large Skull Base Meningioma
A 30-year-old professional musician with rapidly progressive neurological symptoms was found to have a 6–7 cm skull base meningioma compressing critical brain structures. Stephen A. Johnson, MD, performed microsurgical resection with removal of tumor-invaded bone and skull reconstruction.
Rapid neurological decline from a grapefruit-sized tumor
The patient had no prior medical problems when headaches, imbalance, left-sided weakness and mild confusion developed rapidly. Outpatient MRI revealed a large skull base tumor measuring approximately 6–7 cm and compressing critical brain structures.
The challenge extended beyond tumor size. The meningioma involved the skull base bone, requiring a strategy that addressed both deep tumor removal and reconstruction of the involved skull.
Defining the size and extent of the tumor
Preoperative MRI demonstrated the large skull base meningioma and its relationship to the surrounding brain, providing the anatomical roadmap for surgical planning.
Tumor Extent
Imaging demonstrates the large intracranial mass before surgical resection.
Critical Anatomy
Additional imaging defines the tumor’s relationship to the surrounding brain and skull base.
Surgical Planning
Multiple imaging planes help define the full extent of the lesion before surgery.
Resection, involved bone removal and reconstruction
Dr. Johnson developed and executed a comprehensive surgical plan within days of referral. Working with an ENT specialist, he used image-guided navigation to translate the patient’s imaging into a precise intraoperative map.
Image-guided navigation
The system registered the patient’s facial and scalp anatomy to create a GPS-like map for deeper surgical navigation.
Isolate tumor-invaded bone
Using fine microscopic drills, Dr. Johnson separated normal bone from tumor-involved bone, creating an isolated section of abnormal bone for removal.
Microsurgical tumor resection
The tumor was carefully separated from the brain under the operating microscope to achieve total resection.
Reconstruct the skull
Custom mesh reconstruction restored skull integrity after removal of the involved bone.
The patient experienced immediate neurological improvement following surgery and was discharged on postoperative day two.
Follow-up imaging showed the brain naturally filling the space previously occupied by the tumor. Within weeks, the patient returned to normal activities, including traveling for musical performances.
Total resection with recovery of the surrounding brain
Postoperative imaging demonstrates removal of the large skull base meningioma. On follow-up, the brain expanded naturally into the space previously occupied by the tumor.
Total Resection
Brain Recovery
When tumor removal and skull reconstruction are part of the same operation
Large skull base meningiomas can require more than removal of the tumor itself. In this case, tumor involvement of the bone made careful bony resection and reconstruction integral parts of the surgical plan.
Stephen A. Johnson, MD
Dr. Stephen A. Johnson is Director of Skull Base Surgery and specializes in complex brain and skull base tumors. His practice includes microsurgical and image-guided techniques for tumors involving challenging anatomy.
Meet Dr. JohnsonA complex tumor deserves a careful surgical strategy.
If you or a loved one has been diagnosed with a meningioma or skull base tumor, our brain tumor team can review the imaging and help explain the treatment options.
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