Different Surgical Approaches in Anterior Skull Base Meningiomas: Our Experience of a Surgical Series and Literature Review

Objective: To this day anterior skull base meningiomas still remain a surgical challenge. In our work, we review a series of anterior base meningiomas operated on from 1990 to 2010 and compare our data with papers in the literature.

Methods: From 165 patients operated on for skull base meningioma, we selected 73 cases divided into four main groups: olfactory groove (22 cases), suprasellar (23), anterior clinoid (17), and orbital roof/mixed (11). In all cases, a pterional craniotomy was performed with anterior or posterior extension. We examined the first three groups of meningiomas (clinoid, olfactory groove, and tuberculum sellae) and compared our data with the literature.

Results: We obtained a total removal of meningiomas in 83% of patients with a Simpson grade I or II. In the remnant cases, we only achieved subtotal removal due to the involvement of vital neurovascular structures. Postoperative outcome was good in 90%. In our series and in data collected from literature, clinoid meningiomas showed evidence of a poor prognosis in terms of Simpson and KPS grade; however, the olfactory groove location provided better results regarding outcome and symptom relief. The pterional surgical approach was used primarily for clinoid and tuberculum sellae meningiomas, but the olfactory groove frontal approach and its variations were preferred by many authors.

Conclusions: Surgical planning and outcome of anterior base meningiomas may vary considerably. Modern diagnostic evaluations allow further tailoring of surgical treatment, resulting in a good removal rate with less morbidity and recurrence.