The Skuba Classification: The First Comprehensive Anatomic Classification for Skull Base Meningiomas

BACKGROUND AND OBJECTIVES: Skull base meningiomas remain challenging to classify because of the existence of numerous, partially overlapping anatomic classification systems in current literature. The objective of this study was to systematically synthesize high-quality anatomic classifications into a single, comprehensive framework. By providing a unified classification system, this study aimed to improve (interdisciplinary) communication, facilitate clinical decision-making, and enhance consistency in research and reporting related to skull base meningiomas. METHODS: A systematic review was conducted using PubMed, Google Scholar, and Embase (last consulted on June, 2024). All articles were screened based on title, abstract, and full text. Included studies provided an accurate description of skull base meningioma categories and their anatomic characteristics. Articles were excluded if they included fewer than 5 patients, used a classification system unrelated to the anatomy of dural attachment, were written in a language other than English or Dutch without translation, included only pediatric patients, or classified mixed tumor types beyond meningiomas. Through this process, 56 articles were included. Articles were evaluated using predefined data extraction parameters and assigned a quality score (0-5), with data from the highest-scoring studies used to construct the final classification for each meningioma category. Extracted meningioma categories were represented as color-coded anatomic regions corresponding to their dural attachment and overlaid on a high-resolution two-dimensional rendering of the osseous skull base. RESULTS: Among the 56 included articles, 16 anatomically distinct categories of skull base meningiomas were identified. The 2-dimensional color-coded atlas of the classification is made available online at: https://sbfocus.nl/skuba-classification-poster. CONCLUSION: We present the first comprehensive anatomic classification of skull base meningiomas, extracted in a systematic fashion from the literature. This classification could improve future research and clinical communication in meningioma patient care.