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

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.


 

  • References

  • 1 Muskens IS, Briceno V, Ouwehand TL. , et al. The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas-a meta-analysis. Acta Neurochir (Wien) 2018; 160 (01) 59-75
    CrossrefPubMedGoogle Scholar
  • 2 Linsler S, Fischer G, Skliarenko V, Stadie A, Oertel J. Endoscopic assisted supraorbital keyhole approach or endoscopic endonasal approach in cases of tuberculum sellae meningioma: which surgical route should be favored?. World Neurosurg 2017; 104: 601-611
    CrossrefPubMedGoogle Scholar
  • 3 Kshettry VR, Elshazly K, Evans JJ. Endoscopic transnasal surgery for planum and tuberculum sella meningiomas: decision-making, technique and outcomes. CNS Oncol 2016; 5 (04) 211-222
    CrossrefPubMedGoogle Scholar
  • 4 Schroeder HW. Indications and limitations of the endoscopic endonasal approach for anterior cranial base meningiomas. World Neurosurg 2014; 82 (6, Suppl): S81-S85
    CrossrefPubMedGoogle Scholar
  • 5 Clark AJ, Jahangiri A, Garcia RM. , et al. Endoscopic surgery for tuberculum sellae meningiomas: a systematic review and meta-analysis. Neurosurg Rev 2013; 36 (03) 349-359
    CrossrefPubMedGoogle Scholar
  • 6 Ruggeri AG, Cappelletti M, Fazzolari B, Marotta N, Delfini R. Fronto-basal midline meningiomas: is it right to shed doubt on the transcranial approaches? Updates and review of the literature. World Neurosurg 2016; 88: 374-382
    CrossrefPubMedGoogle Scholar
  • 7 Elshazly K, Kshettry VR, Farrell CJ, Nyquist G, Rosen M, Evans JJ. Clinical outcome after endoscopic endonasal resection of tuberculum sella meningiomas. Oper Neurosurg (Hagerstown) 2018; 14 (05) 494-502
    PubMedGoogle Scholar
  • 8 Song SW, Kim YH, Kim JW. , et al. Outcomes after transcranial and endoscopic endonasal approach for tuberculum meningiomas-a retrospective comparison. World Neurosurg 2018; 109: e434-e445
    CrossrefPubMedGoogle Scholar
  • 9 Shetty SR, Ruiz-Treviño AS, Omay SB, Almeida JP, Liang B, Chen YN. , et al. Limitations of the endonasal endoscopic approach in treating olfactory groove meningiomas. A systematic review. Acta Neurochir (Wien) 2017; 159 (10) 1875-1885
    CrossrefPubMedGoogle Scholar
  • 10 Turel MK, Tsermoulas G, Reddy D, Andrade-Barazarte H, Zadeh G, Gentili F. Endonasal endoscopic transsphenoidal excision of tuberculum sellae meningiomas: a systematic review. J Neurosurg Sci 2016; 60 (04) 463-475
    PubMedGoogle Scholar
  • 11 Ditzel Filho LF, Prevedello DM, Jamshidi AO. , et al. Endoscopic Endonasal Approach for Removal of Tuberculum Sellae Meningiomas. Neurosurg Clin N Am 2015; 26 (03) 349-361
    CrossrefPubMedGoogle Scholar
  • 12 Ajlan AM, Choudhri O, Hwang P, Harsh G. Meningiomas of the tuberculum and diaphragma sellae. J Neurol Surg B Skull Base 2015; 76 (01) 74-79
    PubMedGoogle Scholar
  • 13 Brunworth J, Padhye V, Bassiouni A. , et al. Update on endoscopic endonasal resection of skull base meningiomas. Int Forum Allergy Rhinol 2015; 5 (04) 344-352
    CrossrefPubMedGoogle Scholar
  • 14 Koutourousiou M, Fernandez-Miranda JC, Stefko ST, Wang EW, Snyderman CH, Gardner PA. Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients. J Neurosurg 2014; 120 (06) 1326-1339
    CrossrefPubMedGoogle Scholar
  • 15 Koutourousiou M, Fernandez-Miranda JC, Wang EW, Snyderman CH, Gardner PA. Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients. Neurosurg Focus 2014; 37 (04) E8
    Google Scholar
  • 16 Van Gompel JJ, Frank G, Pasquini E, Zoli M, Hoover J, Lanzino G. Expanded endonasal endoscopic resection of anterior fossa meningiomas: report of 13 cases and meta-analysis of the literature. Neurosurg Focus 2011; 30 (05) E15
    PubMedGoogle Scholar
  • 17 Khan OH, Krischek B, Holliman D. , et al. Pure endoscopic expanded endonasal approach for olfactory groove and tuberculum sellae meningiomas. J Clin Neurosci 2014; 21 (06) 927-933
    CrossrefPubMedGoogle Scholar
  • 18 Mascarella MA, Tewfik MA, Aldosari M, Sirhan D, Zeitouni A, Di Maio S. A simple scoring system to predict the resectability of skull base meningiomas via an endoscopic endonasal approach. World Neurosurg 2016; 91: 582-591.e1
    CrossrefPubMedGoogle Scholar
  • 19 Khan OH, Anand VK, Schwartz TH. Endoscopic endonasal resection of skull base meningiomas: the significance of a “cortical cuff” and brain edema compared with careful case selection and surgical experience in predicting morbidity and extent of resection. Neurosurg Focus 2014; 37 (04) E7
    CrossrefPubMedGoogle Scholar
  • 20 Ottenhausen M, Banu MA, Placantonakis DG. , et al. Endoscopic endonasal resection of suprasellar meningiomas: the importance of case selection and experience in determining extent of resection, visual improvement, and complications. World Neurosurg 2014; 82 (3-4): 442-449
    CrossrefPubMedGoogle Scholar
  • 21 Jones SH, Iannone AF, Patel KS. , et al. The impact of age on long term quality of life after endonasal endoscopic resection of skull base meningiomas. Neurosurgery 2016; 79 (05) 736-745
    CrossrefPubMedGoogle Scholar
  • 22 Abbassy M, Woodard TD, Sindwani R, Recinos PF. An overview of anterior skull base meningiomas and the endoscopic endonasal approach. Otolaryngol Clin North Am 2016; 49 (01) 141-152
    CrossrefPubMedGoogle Scholar
  • 23 Padhye V, Naidoo Y, Alexander H. , et al. Endoscopic endonasal resection of anterior skull base meningiomas. Otolaryngol Head Neck Surg 2012; 147 (03) 575-582
    CrossrefPubMedGoogle Scholar
  • 24 Banu MA, Mehta A, Ottenhausen M. , et al. Endoscope-assisted endonasal versus supraorbital keyhole resection of olfactory groove meningiomas: comparison and combination of 2 minimally invasive approaches. J Neurosurg 2016; 124 (03) 605-620
    CrossrefPubMedGoogle Scholar
  • 25 Liu JK, Silva NA, Sevak IA, Eloy JA. Transbasal versus endoscopic endonasal versus combined approaches for olfactory groove meningiomas: importance of approach selection. Neurosurg Focus 2018; 44 (04) E8
    CrossrefPubMedGoogle Scholar
  • 26 Karsy M, Raheja A, Eli I, Guan J, Couldwell WT. Clinical outcomes with transcranial resection of the tuberculum sellae meningioma. World Neurosurg 2017; 108: 748-755
    CrossrefPubMedGoogle Scholar
  • 27 Mortazavi MM, Brito da Silva H, Ferreira Jr. M, Barber JK, Pridgeon JS, Sekhar LN. Planum sphenoidale and tuberculum sellae meningiomas: operative nuances of a modern surgical technique with outcome and proposal of a new classification system. World Neurosurg 2016; 86: 270-286
    CrossrefPubMedGoogle Scholar
  • 28 Zoli M, Manzoli L, Bonfatti R. , et al. Endoscopic endonasal anatomy of the ophthalmic artery in the optic canal. Acta Neurochir (Wien) 2016; 158 (07) 1343-1350
    CrossrefPubMedGoogle Scholar
  • 29 Attia M, Kandasamy J, Jakimovski D. , et al. The importance and timing of optic canal exploration and decompression during endoscopic endonasal resection of tuberculum sella and planum sphenoidale meningiomas. Neurosurgery 2012; 71 (1, Suppl operative): 58-67
    CrossrefPubMedGoogle Scholar
  • 30 Abhinav K, Acosta Y, Wang WH. , et al. Endoscopic Endonasal Approach to the Optic Canal: Anatomic Considerations and Surgical Relevance. Neurosurgery 2015; 11 (Suppl. 03) 431-445 , discussion 445–446
    CrossrefPubMedGoogle Scholar
  • 31 Garcia-Navarro V, Anand VK, Schwartz TH. Gasket seal closure for extended endonasal endoscopic skull base surgery: efficacy in a large case series. World Neurosurg 2013; 80 (05) 563-568
    CrossrefPubMedGoogle Scholar
  • 32 Hadad G, Bassagasteguy L, Carrau RL. , et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116 (10) 1882-1886
    CrossrefPubMedGoogle Scholar