<![CDATA[Meningioma is the most common primary intracranial tumor in adults, accounting for approximately 37.6% of all primary central nervous system neoplasms. Although convexity meningiomas are generally surgically accessible, large tumors with neurovascular involvement present significant operative challenges, especially when acute neurological deterioration necessitates emergent intervention. A 46-year-old female presented with decreased consciousness (GCS E2V3M4) and progressive hemiparesis. Preoperative CT revealed a large temporoparietal extra-axial mass with significant mass effect and middle cerebral artery (MCA) involvement. Emergent craniotomy and stepwise debulking were performed utilizing gravity-assisted retraction, central dural incision, pial plane preservation, early arterial feeder coagulation, and systematic hemostasis. The philosophy of prioritizing patient safety over gross total resection guided the strategy. Postoperatively, the patient regained full consciousness (GCS E4V5M6) with marked motor improvement. Emerging evidence supports subtotal resection with adjuvant stereotactic radiosurgery for residual tumors. Emergent surgical debulking of large convexity meningiomas with neurovascular involvement is feasible and effective when guided by stepwise resection, pial plane preservation, and patient safety. Adjuvant radiosurgery should be considered for any residual tumor on follow-up imaging.]]>
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