Giant and Large Anterior Clinoid Meningiomas Encasing Major Arteries: Single-Center Experience and Literature Review

Objective. The aim of this study was to evaluate postoperative and long-term outcomes in patients undergoing anterior clinoid process (APC) meningioma resection complicated by vascular injury.Design. We retrospectively analyzed a consecutive clinical series and conducted a non systematic literature review.Setting. This study was conducted at the Tertiary Academic Medical Center. Methods. We retrospectively analyzed a consecutive clinical series and conducted a non-systematic literature review. Results. Thirteen patients were included. Mean age was 62.1 years, mean tumor volume was 307.3 cm³, and mean follow-up was 54.3 months. The internal carotid artery (ICA) was involved in all cases, with complete circumferential encasement in 50%. GTR was achieved in all patients.Postoperatively, three patients developed hemiparesis and one developed left hemiplegia. Two patients experienced ischemic stroke; one was treated with middle cerebral artery (MCA) stenting.At final follow-up, all patients demonstrated neurological improvement, with a mean Karnofsky Performance Status (KPS) of 92.5. Review included 27 studies encompassing 691 patients.Vascular com-plications were reported in 44 cases (6.4%). Direct intraoperative arterial injury was the predominant mechanism (77%), while severe vasospasm accounted for 23%. Post-operative hemiparesis occurred in 16 patients (36.4%). One case of persistent hemiplegia was reported at long-term follow-up and seven deaths were documented. Conclusions. ACP meningiomas encasing major arteries are associated with a significant risk of severe vascular complications. Vasospasm and direct arterial injury may result in devastating ischemic stroke. Further studies are required to define optimal management strategies and clarify the prognostic impact of vascular complications on long-term outcomes.