Meningiomas of the Anterior Skull Base Resected via an Endonasal Endoscopic Approach: Outcomes and Complications

Introduction: The expanded endonasal approach (EEA) provides a completely transnasal endoscopic corridor to the median and paramedian anterior cranial fossa.

Methods: We retrospectively reviewed 67 patients (ages, 26–83 years; mean age, 58 years) with anterior fossa meningiomas who underwent a single or staged EEA for cytoreduction. Anterior skull base meningiomas were divided into those with (45 patients) or without (22 patients) associated visual compromise (defined as either symptomatic visual deficits or compression/impingement of the optic apparatus on neuroimaging). Pre- and postoperative volumetric tumor calculations were performed. Follow-up ranged from 1–63 months (mean, 16.5 months).

Results: Gross total resection by imaging was achieved in 47 patients (70%): gross total resection was achieved in 17 of 22 (77%) meningiomas without visual compromise and in 27 of 45 (60%) meningiomas with compromise of the optic apparatus. There was no mortality after 30 days. The most common complication was CSF leak (34%), which decreased after the institution of a vascularized nasoseptal flap for reconstruction. A subgroup analysis of pre- and post-flap CSF leak will be presented. Among 45 patients who presented with vision loss, vision improved or remained stable in 41 (91%). Vision worsened in 4 patients (6%). Other complications included hypopituitarism (1.5%), seizures (4.5%), DVT/PE (6%), intracranial hemorrhage (1.5%), and bacterial meningitis (1.5%).

Conclusion: Meningiomas of the anterior skull base can be successfully and safely resected via a complete transnasal endoscopic approach. The endocrine and visual morbidity of EEA for anterior fossa meningiomas compares favorably with transcranial approaches.