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J Neurol Surg B Skull Base 2021; 82(05): 500-505
DOI: 10.1055/s-0040-1714111
Original Article

Endoscopic Transnasal Resection of Midline Skull Base Meningiomas: Tumor Consistency and Surgical Outcomes

Hissah K. Al Abdulsalam
1   Department of Neurosurgery, King Saud University, Riyadh, Saudi Arabia
,
Aljohara K. Aldahish
2   Department of Surgery, Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Abdulrahman Albakr
2   Department of Surgery, Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Sajjad Hussain
3   Department of Radiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Ahmad Alroqi
4   Otolaryngology–Head and Neck Surgery Department, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
,
Saud Alromaih
4   Otolaryngology–Head and Neck Surgery Department, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
,
Saad Alsaleh
4   Otolaryngology–Head and Neck Surgery Department, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
,
Abdulrazag M. Ajlan
2   Department of Surgery, Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
5   Department of Neurosurgery, Stanford School of Medicine, Palo Alto, California, United States
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Abstract

Background The endoscopic transnasal approach (ETA) has proven to be of great value in the resection of midline skull base meningiomas when compared with traditional approaches. Our objective was to assess tumor consistency in relation to surgical outcomes for midline meningiomas (MMs) resected using ETA.

Methods Radiological preoperative features, including the tumor to cerebellar peduncle T2-weighted magnetic resonance imaging (MRI) ratio (TCTI), were evaluated. The intraoperative consistency assessment was performed by the surgeon, which determined if the tumor was soft (resectable by suction) or firm (required a cavitation ultrasonic aspirator). Surgical resection and postoperative complications were evaluated in relation to tumor consistency.

Results Twenty patients were evaluated; 6 were classified as firm and 14 were classified as soft. The mean TCTI ratio was 1.7 and the median was 1.7 (range: 1.3–2.4). Three firm tumors had a ratio of <1.6. All soft tumors had a ratio of ≥1.6 with three outliers. Additionally, 66.7% of patients with firm tumors had complications compared with 35.7% of patients with soft tumors. Only 33.3% of firm tumors underwent gross total resection (GTR) in comparison to 79.0% of tumors with a soft consistency.

Conclusion In our analysis, we found that tumor consistency was significantly related to short-term surgical outcomes in MMs resected using the ETA. The TCTI ratio was found to be the most reliable predictor with a sensitivity of 76.9% and a specificity of 40.0%. Our findings suggest that traditional cranial approaches should be considered as the first surgical option for managing firm MMs.

Keywords

meningioma - tumor consistency - magnetic resonance imaging - surgical outcome

Note

This manuscript has not been published and is not under consideration by another journal. However, a portion of this work was presented in oral format at the 12th SANS Meeting, Riyadh, Saudi Arabia, April 2018.




Publication History

Received: 08 November 2019

Accepted: 18 May 2020

Article published online:
10 September 2020

© 2020. Thieme. All rights reserved.

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