gms | German Medical Science

Objective: Several publications describe so-called "extended" endoscopic endonasal transsphenoidal approaches (EETA), while treating meningiomas of the frontal central skull base. EETA is explained as minimally invasive, compared with extended and standard craniotomies. However, minimally invasiveness of EETA should be critically analyzed. Critical points are the 1) approach related traumatisation of the nasal cavity, 2) limited manoeuvrability of surgical instruments and 3) enormous problems with skull base reconstruction avoiding postoperative CSF leakage.

Methods: This publication report author's experience with the keyhole endoscopic transcranial approach (KETA) in the treatment of frontal skull base meningiomas. In 75 consecutive cases a supraorbital eyebrow craniotomy was performed. The tumours were localised in the olfactory groove (n=19), anterior clinoid process and sphenoid wing (n=24), planum sellae (n=23) and at the cavernous sinus (n=9).

Results: Postoperative GOS was 5 in 69 cases, 4 in 7 cases; complications included visual impairment in 5 cases, oculomotor palsy in 2 cases and pituitary insufficiency in 1 case. In 1 case CSF leak could be detected through the penetrated frontal sinus, revealing surgical revision. MRI 3 months after surgery showed in 68 cases total removal, in 5 cases subtotal and in 2 cases partial tumour resection. Cosmetic outcome was in all cases excellent.

Conclusions: Critically compared with the EETA, KETA via supraorbital eyebrow craniotomy offered excellent surgical results according to the unrestricted surgical manipulation and low surgical morbidity according to a minimally invasive keyhole craniotomy. As a transcranial exposure, KETA caused no nasal complications and very low incidence of CSF leakage.