Article
The frontolateral approach for the treatment of anterior cranial base and perisellar meningioma: results of 65 cases with focus on perioperative approach-related morbidity and mortality
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Authors
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Helen M. Steiner
- Universitätsklinik für Neurochirurgie, Eberhard-Karls-Universität Tübingen
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Stephan Herlan
- Universitätsklinik für Neurochirurgie, Eberhard-Karls-Universität Tübingen
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Florian H. Ebner
- Universitätsklinik für Neurochirurgie, Eberhard-Karls-Universität Tübingen
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Marcos Tatagiba
- Universitätsklinik für Neurochirurgie, Eberhard-Karls-Universität Tübingen
| Published: | June 2, 2015 |
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Outline
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Objective: To analyze our surgical series of patients that underwent microsurgical resection of anterior cranial base or perisellar region meningiomas using the frontolateral approach. We performed a review of the literature, regarding the use of the frontolateral approach with a special focus on perioperative approach-related morbidity and mortality.
Method: In a retrospective study we analyzed the patients' charts, operating reports, pre- and postoperative imaging, ICU charts and follow-up data of all patients operated on a perisellar or frontal base meningioma at our Department of Neurosurgery between January 2006 and December 2011. Only patients operated through a frontolateral approach were included in the study.
Results: Between January 2006 and December 2011 65 patients were operated on a meningioma of the anterior cranial base or perisellar region using the frontolateral approach. The distribution regarding the gender was 15 men (23,1%) and 50 women (76,9%). The mean age in females was 58 years (SD: 11 years) and in males 49 years (SD: 18 years). Total tumor resection (Simpson I-II) was achieved in 53 patients (82,8%). The postoperative mortality was 0%. 5 Patients (7,7%) needed intraoperative blood transfusions which correlated significantly with the tumor size. 4 patients (6,2%) developed a CSF-leak, 2 patients (3,1%) had postoperative brain edema, one patient (1,5%) developed a postoperative diabetes insipidus and two patients (3,1%) had a temporary palsy of the frontal branch. If a CSF-leak occurred, it caused significant prolongation of the hospitalization time. In case of preoperative visual deficits, the visual function improved in 11 patients (61,1%). The mean follow-up was 21,0 months (SD: 21,6 months), tumor recurrence occurred in only one patient (2,9%) 36 months after the surgery. Our approach-related results are compared to the other standard approaches for this region (pterional, subfrontal and endoscopic transnasal approaches).
Conclusions: The frontolateral approach can be successfully used for the treatment of anterior cranial base and perisellar meningioma of all sizes. Blood loss showed a significant correlation to the tumor size. Compared to the results of the alternative approaches reported in literature, the frontolateral approach showed a low rate of morbidity and mortality. Even though low, CSF-leak turned out to be the main problem displayed in the incidence and prolongation of hospitalization time.
