A Multi-institutional Comparison of Transcranial versus Endoscopic Endonasal Approaches for Planum and Tuberculum Sellae Meningiomas

Introduction: The indications, outcomes, and limitations of endoscopic endonasal approach (EEA) versus transcranial (TC) approach for the resection of planum and tuberculum meningiomas remains controversial. We sought to evaluate the surgical outcomes from two institutions with polarized preferences and expansive experience in endoscopic endonasal (EEA) and transcranial approaches (TC) at each one.

Methods: We performed a retrospective review of 56 patients who underwent TC resection of a planum or tuberculum sella meningioma and 65 patients who underwent EEA at 2 high volume academic centers between 2012 and 2018. We compared patient demographics, tumor characteristics, and surgical outcomes between the two cohorts.

Results: There were no significant differences between the two cohorts in average patient age (56.2 years TC vs. 55.9 EEA), sex (43/56 female TC vs. 49/65 EEA), presenting symptoms (vision loss in 37/56 TC vs. 47/65 EEA), or BMI (28.7 TC vs. 29.6 EEA). During a similar follow-up period (16.9 months for TC, and 18.6 months for EEA, p = 0.6), 66% (37/56) of patients were free of disease after TC approaches and 65% (42/65) after EEA (p = 0.87). After TC, 25% (14/56) of patients had stable residual tumor versus 27% (16/65) after EEA (p = 0.96), while 1.8% (1/56) after TC had progression of disease during follow-up versus 7.6% (5/65) of patients after EEA (p = 0.14). There was no significant difference between the two cohorts in average length of surgery (5 hours TC vs. 6 hours EEA p = 0.7) or average length of hospital stay (3.9 days TC vs. 4.9 days for EEA, p = 0.7). Rates of CSF leaks (5.3% for TC vs. 4.6% for EEA, p = 1.0) and meningitis (1 for TC vs. 0 for EEA) were comparable.

Conclusion: In our study, the overall outcomes after endoscopic endonasal or transcranial approaches for the resection of planum or tuberculum meningiomas in experienced hands were very similar. As such the choice of approach may in part be dictated by the comfort level and training of the surgeon in each approach.