The Endoscopic Endonasal Management of Anterior Skull Base Meningiomas

Matteo Zoli, Federica Guaraldi, Ernesto Pasquini, Giorgio Frank, Diego Mazzatenta

Research output: Contribution to journalArticle

Abstract

Introduction: The endoscopic endonasal approach (EEA) might seem an unnatural route for intradural lesions such as meningiomas. The aim of this study is to critically revise our management of anterior skull base meningiomas to consider, in what cases it may be advantageous. Material and Methods: Each consecutive case of anterior skull base meningioma operated on through an EEA or combined endoscopic-transcranial approach at our institution, between 2003 and 2017, have been included. Tumors were classified on the basis of their location and intra or extracranial extension. Follow-up consisted of an MRI (magnetic resonance imaging) and a clinical examination 3 months after the surgery and then repeated annually. Results: Fifty-seven patients were included. The most common location was the tuberculum sellae (62%), followed by olfactory groove (14%), planum sphenoidale (12%), and frontal sinus (12%). Among these, 65% were intracranial, 7% were extracranial, and 28% both intra and extracranial. Radical removal was achieved in 44 cases (77%). Complications consisted in 10 CSF (cerebrospinal fluid) leaks (17.6%), 1 overpacking (1.7%), and 1 asymptomatic brain ischemia (1.7%). Visual acuity and campimetric deficits improved respectively in 67 and 76% of patients. Recurrence rate was of 14%. Conclusions: EEA presents many advantages in selected cases of anterior skull base meningioma. However, it is hampered by the relevant risk of CSF leak. We consider that it could be advantageous for planum/tuberculum sellae tumors. Conversely, for olfactory groove or frontal sinus meningiomas, it can be indicated for tumors with extracranial extension, while its role is still debatable for purely intracranial forms as considering our surgical results, it could be advantageous for midline planum/tuberculum sellae tumors. Conversely, it can be of first choice for olfactory groove or frontal sinus meningiomas with extracranial extension, while its role for purely intracranial forms is still debatable.

Original languageEnglish
Pages (from-to)S300-S310
JournalJournal of Neurological Surgery, Part B: Skull Base
Volume79
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

Keywords

  • anterior skull base
  • endoscopic endonasal surgery
  • frontal sinus
  • meningiomas
  • olfactory groove
  • transcranial approaches
  • tuberculum sellae

ASJC Scopus subject areas

  • Clinical Neurology

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