Extra-Axial Neoplasms and Meningiomas — WACS Viva & Clinical Scenarios (Neuro-Oncology and Skull Base Disorders)

Exam-style extra-axial neoplasms and meningiomas viva scenarios with examiner probes and model answers for Neurosurgery candidates.

Scenarios covered

• SCENARIO 1: Detail the World Health Organization (WHO) grading system for meningiomas, describing the defining histological criteria and molecular markers for Grade 1, Grade 2 (atypical), and Grade 3 (anaplastic/malignant) subtypes, and explain the clinical significance of Simpson resection grading in predicting recurrence.
• SCENARIO 2: A 48-year-old female presents with progressive right-sided lower extremity weakness and focal seizures. Magnetic resonance imaging demonstrates an 4.5 cm contrast-enhancing mass in the middle third of the superior sagittal sinus with partial sinus lumen compromise. Detail your preoperative diagnostic workup, surgical approach, intraoperative management of the sagittal sinus, and postoperative complication surveillance.
• SCENARIO 3: Describe the clinical presentation, anatomical boundaries, surgical approach options, and anterior skull base reconstruction techniques for a giant olfactory groove meningioma extending into the ethmoid sinuses.
• SCENARIO 4: Differentiate the clinical presentation, neurovascular risks, and surgical strategies for sphenoid wing meningiomas based on their anatomical subdivision into inner (clinoidal), middle (alar), and outer (pterional) thirds.
• SCENARIO 5: Outline the clinical presentation, diagnostic neuroimaging characteristics, surgical skull base corridors, and cranial nerve preservation strategies for a vestibular schwannoma (Koos Grade 3) in a patient with salvageable hearing.