Article
The endoscope-assisted supraorbital approach for surgical treatment of large frontobasal meningeomas
Resektion von ausgedehnten frontobasalen Meningeomen über den endoskop-assistierten supraorbitalen Zugangsweg
Search Medline for
Authors
-
R. Reisch
- Neurochirurgische Klinik Mainz
-
A. Perneczky
- Neurochirurgische Klinik Mainz
| Published: | May 8, 2006 |
|---|
Outline
Text
Objective: Large frontobasal meningeomas are usually exposed through extended bifrontal or frontotemporal skull base approaches.
Methods: Between Juli 1996 and June 2005, the supraorbital key hole craniotomy through eyebrow skin incision was used in our department in 1194 cases. The supraorbital, lateral subfrontal approach avoided removal of the orbital rim, lesser sphenoid wing or the zygomatic arch. During this ten-year-period, the authors have performed 541 supraorbital craniotomies. These cases were retrospectively analyzed, relevant records of 511 patients were available. Of these patients, 165 were treated as skull base meningeomas, the tumor matrix was localized in the olfactory groove and the planum sphenoidale 70 cases (42%), at the anterior clinoid process and sphenoid wing in 58 cases (35%) and in 37 cases (22%) at the dorsum and diaphragma sellae. Of the 70 patients with frontobasal tumors, 41 had large (>3cm) and 6 giant (>6cm) tumors, none of the tumors showed extracranial extension into the ethmoid cells or the nasal cavitiy.
Results: The limited supraorbital craniotomy allowed sufficient surgical exposure and safe removal of the frontobasal meningeomas. In order to increase the intraoperative optical control, we have utilized the endoscope-assisted microsurgical technique in 43 cases (61%). The endoscopic visualization allowed increased optical control on surgical dissection with a clear depiction of patho-anatomical details. Using 0° and 30° endoscopes, the tumor removal could be effectively controlled in hidden parts of the surgical field, especially within the olfactory groove and behind the christa galli. Three months after the operation, the MRI showed complete,removal in 66 cases (94%), subtotal removal in 4 cases (6%). None of the cases had partial tumor removal. There were no approach or technique related intracranial complications. Furthermore, none of the patients had postoperative seizures.
Conclusions: The minimally invasive, endoscope-assisted supraorbital craniotomy offered adequate surgical exposure of fthe frontobasal meningeomas without using extended skull base approaches. The short skin incision within the eyebrow, careful soft tissue dissection and limited osteodestruction resulted in decreased approach- related complications and a pleasing cosmetic outcome after surgery.
