gms | German Medical Science

Objective: Removal of anterior skull base meningiomas is traditionally performed through transcranial approaches. The wide use of the endoscope for pituitary surgery has led to the development of endoscopic expanded endonasal approaches. In this study, we report our experience using this approach for the removal of anterior skull base meningiomas that border on the paranasal sinuses.

Method: We describe our current endoscopic endonasal technique and demonstrate the feasibility of using it to access anterior cranial base meningiomas from the back wall of the frontal sinus to the sella and laterally to the region of the midorbit. We address safety and efficacy of this technique and the outcome of nineteen treated anterior skull base meningiomas.

Results: Between May 2006 and October 2012, nineteen patients underwent pure transnasal endoscopic resection of anterior skull base meningiomas. The presenting symptom in the majority (12/19) was visual disturbance. Postoperatively, most experienced resolution or improvement of visual symptoms (7/12). The maximum diameter of the tumour ranged from 1 cm to 5.2 cm (average 2,7 cm). A gross total resection (Simpson grade I and II) was achieved in fourteen patients (74%). There was no perioperative disease-related mortality. Postoperative cerebrospinal fluid (CSF) leaks occurred in three patients (16%), of which two underwent revision and one was managed by placement of lumbar drainage alone.

Conclusions: By using the endonasal endoscopic approach rates of gross total resection similar to transcranial approaches can be achieved. It has acceptable morbidity and mortality rates. The postoperative CSF leak rate has been reduced substantially after implementation of the vascularized pedicled flap. The endonasal endoscopic approach can be a safe and effective alternative for the treatment of anterior skull base meningiomas.