Single-stage microscopic and endoscopic resection of spatially separate meningiomas through a single craniotomy

Background: Multiple meningiomas are frequently encountered; however, determining the optimal surgical strategy for single-stage resection can be challenging. Conventional approaches include performing multiple craniotomies or a single large craniotomy encompassing both lesions, which may be overly invasive depending on patient factors and tumor characteristics. Endoscopic approaches have increasingly been used to reduce the invasiveness of meningioma surgery, but their application to multiple lesions remains limited. Case Description: An 85-year-old man with incidentally discovered meningiomas located in the left parasagittal region (primary lesion) and the right convexity (separate lesion) underwent single-stage resection of both lesions. Based on meticulous preoperative simulation, both lesions were removed through a small craniotomy (3.5 × 2.5 cm) placed directly over the primary lesion. The parasagittal tumor was removed microscopically, while the separate convexity lesion was resected endoscopically. Endoscopic visualization enabled access to and resection of the separate lesion without additional bone removal. Conclusion: For selected patients deemed feasible and safe based on preoperative simulation, endoscopic resection of an additional convexity lesion located beyond the craniotomy site may provide a less invasive alternative to multiple or extended craniotomies. This approach may be beneficial for older adults, for whom minimizing surgical invasiveness is essential.