Article
Meningiomas in the canyon: The choice between subcranial trans frontal sinus (TfSA) and endonasal approach (EEa)
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Authors
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Roberto Stefini
- Division of Neurosurgery, Department of Neuroscience, Division of Neurosurgery, University of Brescia, Brescia, Italy
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Francesco Zenga
- Clinica Neurochirurgica, Università di Torino e A.S.O. San Giovanni Battista – Molinette, Torino, Italy
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Andrea Bolzoni
- Division of Neurosurgery, Department of Neuroscience, Division of Neurosurgery, University of Brescia, Brescia, Italy
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Fulvio Tartara
- Istituti Spitalieri, Cremona, Italy
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Alessandro Ducati
- Clinica Neurochirurgica, Università di Torino e A.S.O. San Giovanni Battista – Molinette, Torino, Italy
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Marco Fontanella
- Clinica Neurochirurgica, Università di Torino e A.S.O. San Giovanni Battista – Molinette, Torino, Italy
| Published: | June 2, 2015 |
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Outline
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Objective: The aim of this study is to present our surgical experience in removal of anterior fossa midline meningiomas (AmM) using the EEa or the TfSa and underline surgical criterias and technical advantages based on anatomical considerations.
Method: 54 patients with AmM underwent surgery with these two different approaches between January 2000 and December 2014, 49 withTfSa and 5 EEa
Results: The olfactory grow meningiomas (OGM) were 45: 1 operated by EEa, and 44 by TfSa. 2 meningiomas operated by a combined approach. The tubercolum sellae meningiomas (TSM) were 6, 2 operated by EEa and 4 by TfSa. The diaphragm sellae meningiomas (DSM) were 3, operated by EEa. Simpson grade I resection was achieved in all OGM and in 3 TSM, while 1 TSM operated by TfSa had Simpson grade IV due to the impossible detachment of the meningioma from both A2 arteries. Simpson grade II resection was achieved in all the 3 DSM. 5 (11,1%) patients operated by TfSa experienced CSF rhinorrhea, treated with external lumbar drain for 4 days and resolved in 4 cases, while 1 patient was re-operated with a combined approach. 1 patient, during the CSF leakage, experienced meningitis at day 7 after surgery and was treated by antibiotic therapy. After one month, he developed hydrocephalus, which was treated with a ventricle peritoneal shunt. One patient died after three days from the operation. From March 2013 patients enrolled in the study underwent pre-surgical neuropsychological test, which was repeated one year after surgery.
Conclusions: The choice of the approach was different according to the site of origin of the meningioma, its volume and its relationship with neurovascular structures. The TfSa has been preferred in case of OGM. The EEa has been used only in one patient with smell impairment and with a small OGM extending only inside the "canyon". In case of TSM the EEa it was preferred if the meningioma did not have any relationship with arteries and if it was located medially to the carotid arteries. The EEa was always preferred in case of DSM where the meningioma was medial to the optic nerves and carotid arteries. The main advantages of TfSa are: no need for brain retraction, preservation of the anatomical integrity of the frontal poles and olfactory nerves, easy and early devascularization of the lesion that allows an almost bloodless removal.
