Surgical treatment of recurrent hyperostotic craniofacial meningioma: a review and tactics analysis

Hyperostotic craniofacial meningiomas (HCM) represent a complex neurosurgical problem due to their widespread infiltrative growth, involvement of critical anatomical structures, and a high risk of recurrence. Treatment of recurrences requires a comprehensive approach taking into account the location, extent of the lesion, and involvement of critical anatomical structures. Purpose: to analyze and summarize current surgical tactics for the treatment of recurrent hyperostotic craniofacial meningiomas, including an assessment of the effectiveness of various surgical approaches, defect reconstruction methods, and adjuvant treatments based on literature data. Materials and methods. An analytical review of the literature and a synthesis of study data were conducted with an emphasis on classification, epidemiology of recurrence, and risk factors for recurrence. An analysis of current surgical tactics for the treatment of recurrent hyperostotic craniofacial meningiomas was performed based on a systematic review of the literature. The review includes data on the use of transcranial, craniofacial, and endonasal endoscopic approaches, as well as reconstruction and adjuvant therapy methods. Results. The recurrence rate of HCM was found to reach 29% with a mean follow-up period of 76.5 months, with 23% of patients experiencing more than one recurrence. The main factors influencing the risk of recurrence are the degree of radical resection, histological grade (WHO), Ki-67 index, and medial tumor spread. Modern surgical approaches, including combined approaches and individual reconstruction of defects, allow for good functional and aesthetic results. The use of stereotactic radiosurgery as an adjuvant method demonstrates high rates of local tumor control. Conclusion. Surgery for recurrent HCM is a safe and effective treatment method that requires careful planning taking into account previous interventions, current tumor spread, and a multidisciplinary approach. Integration of adjuvant radiation therapy into the treatment of recurrences, particularly after subtotal resections and for high-grade tumors, is essential for improving recurrence-free survival.

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