Navigating the Diagnostics and Therapeutics of Giant Meningiomas: A Systematic Insight from the Last 25 Years

Meningiomas are the most common benign tumors of the central nervous system, which may rarely present as giant meningiomas or be multicompartmental, yet there is no synthesized evidence in the literature in this regard. This review aimed to determine the clinico-radiological presentation, surgical management, and postoperative sequelae (histopathology, postoperative complications, and follow-up data) for giant meningiomas. A systematic literature search was conducted on PubMed to identify studies published between 2000 and 2025 using advanced search and Boolean strategy while following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 44 studies (449 patients) were included. Simple descriptive analysis was conducted to get means, frequencies, and percentages, and random-effect meta-analysis was conducted to get pooled estimates for mortality, recurrence, and complication rates calculated. Quality assessment was performed using the Joanna Briggs Institute tool. The pooled mean patient age was 54.6 years, with a slight female predominance (56.6%). The most common symptoms were headache 49.6% (143), visual disturbances 42.3% (122), and psychiatric symptoms 36.1% (104). The majority of tumors were left-sided 38.5% (121), and originated from the anterior skull base 41% (180). Gross total resection (GTR) was achieved in 68.4% (243) patients. World Health Organization (WHO) Grade was I in 80.8% (271) patients, with meningothelial subtype in 35.2% (37). The pooled mean of the follow-up period was 248.16 months, yet this mean is influenced by a small number of studies with extended longitudinal follow-up. The pooled complication rate was 7.01%, the pooled recurrence rate was 2.04%, and mortality was 1.28%. Unlike small meningiomas, the majority of patients with giant meningiomas present with psychiatric disorders, with the majority of tumors achieving GTR in single-staged resection. Despite their WHO Grade I histopathological classification, they have a tendency for local invasion; nevertheless, recurrence after complete resection is minimal.