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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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  • References

  • 1 Baldi I, Engelhardt J, Bonnet C. et al. Epidemiology of meningiomas. Neurochirurgie 2018; 64 (01) 5-14
    CrossrefPubMedSearch in Google Scholar
  • 2 Porter KR, McCarthy BJ, Freels S, Kim Y, Davis FG. Prevalence estimates for primary brain tumors in the United States by age, gender, behavior, and histology. Neuro-oncol 2010; 12 (06) 520-527
    CrossrefPubMedSearch in Google Scholar
  • 3 Durand A, Labrousse F, Jouvet A. et al. WHO grade II and III meningiomas: a study of prognostic factors. J Neurooncol 2009; 95 (03) 367-375
    CrossrefPubMedSearch in Google Scholar
  • 4 Zada G, Başkaya MK, Shah MV. Introduction: surgical management of skull base meningiomas. Neurosurg Focus 2017;43(video suppl2):Intro
  • 5 Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH. Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas. World Neurosurg 2012; 77 (5,6): 713-724
    CrossrefPubMedSearch in Google Scholar
  • 6 de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O, Esposito I. Endoscopic transnasal resection of anterior cranial fossa meningiomas. Neurosurg Focus 2008; 25 (06) E8
    CrossrefPubMedSearch in Google Scholar
  • 7 Solares CA, Fakhri S, Batra PS, Lee J, Lanza DC. Transnasal endoscopic resection of lesions of the clivus: a preliminary report. Laryngoscope 2005; 115 (11) 1917-1922
    CrossrefPubMedSearch in Google Scholar
  • 8 Smith KA, Leever JD, Chamoun RB. Predicting consistency of meningioma by magnetic resonance imaging. J Neurol Surg B Skull Base 2015; 76 (03) 225-229
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Murphy MC, Huston III J, Glaser KJ. et al. Preoperative assessment of meningioma stiffness using magnetic resonance elastography. J Neurosurg 2013; 118 (03) 643-648
    CrossrefPubMedSearch in Google Scholar
  • 10 Kendall B, Pullicino P. Comparison of consistency of meningiomas and CT appearances. Neuroradiology 1979; 18 (04) 173-176
    CrossrefPubMedSearch in Google Scholar
  • 11 Suzuki Y, Sugimoto T, Shibuya M, Sugita K, Patel SJ. Meningiomas: correlation between MRI characteristics and operative findings including consistency. Acta Neurochir (Wien) 1994; 129 (1-2): 39-46
    CrossrefPubMedSearch in Google Scholar
  • 12 Hoover JM, Morris JM, Meyer FB. Use of preoperative magnetic resonance imaging T1 and T2 sequences to determine intraoperative meningioma consistency. Surg Neurol Int 2011; 2: 142
    CrossrefPubMedSearch in Google Scholar
  • 13 Kashimura H, Inoue T, Ogasawara K. et al. Prediction of meningioma consistency using fractional anisotropy value measured by magnetic resonance imaging. J Neurosurg 2007; 107 (04) 784-787
    Search in Google Scholar