Download PDF
J Neurol Surg B Skull Base 2018; 79(S 04): S300-S310
DOI: 10.1055/s-0038-1669463
WFSBS 2016
Georg Thieme Verlag KG Stuttgart · New York

The Endoscopic Endonasal Management of Anterior Skull Base Meningiomas

Matteo Zoli
1   Center of Pituitary and Endoscopic Skull Base Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
2   Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
,
Federica Guaraldi
1   Center of Pituitary and Endoscopic Skull Base Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
2   Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
,
Ernesto Pasquini
3   Department of ENT, Ospedale Bellaria, Bologna, Italy
,
Giorgio Frank
1   Center of Pituitary and Endoscopic Skull Base Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
,
Diego Mazzatenta
1   Center of Pituitary and Endoscopic Skull Base Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
2   Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
› Author Affiliations
Further Information

Publication History

08 March 2018

22 July 2018

Publication Date:
27 August 2018 (online)

Also available at
   Permissions and Reprints
Zoom Image

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.

Keywords

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

Note

The authors state that the content of the submitting manuscript, in part or in full, has not been published previously, and has not been submitted elsewhere for review. There is no financial support received in conjunction with the generation of this submission and no conflict of interest. The Authors certify that this manuscript is a unique submission and is not being considered for publication with any other source in any medium. The Authors have nothing to declare and nothing to disclose.