Artikel
Supraorbital approach for meningiomas of the anterior skull base
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Autoren
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Alf Giese
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Deutschland
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Florian Oehlschlägel
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum München, Deutschland
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Clemens Sommer
- Institut für Neuropathologie, Universitätsmedizin Mainz, Deutschland
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Angelika Gutenberg
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Deutschland
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Ali Ayyad
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Deutschland
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
Text
Objective: Meningiomas of the anterior skull base may be approached by a variety of surgical routes. The supraorbital key whole approach attempts to minimize brain and soft tissue trauma. This approach however, is associated with specific risks and cosmetic challenges. Here we review a 20 years mono-institutional experience in 128 patients with meningiomas of the anterior skull base.
Method: A retrospective chart analysis identified 183 patients treated for meningiomas using the supraorbital approach between 1994 and 2013. 128 patients had meningiomas of the anterior skull base. Reviewed by WHO 2007 criteria 3% of tumors were grade II. Epidemiological parameters and tumor location, presenting symptoms, intra- and postoperative adverse events, with special attention to approach related complications and neurological outcome, recurrence and survival were analyzed.
Results: Median age was 57,8 years, 79,7% were female, 95% were newly diagnosed tumors. 68% patients were symptomatic, mostly with disturbance of the visual pathway. Complete resections (Simpson grade I and II) were achieved in 92.9%. However, the overall recurrence rate was 13.3% over a relatively short follow-up of 2,01 ± 3,14 years (range 0,03-17,80). New postoperative neurological deficits occurred in 13.3%, approach related adverse events were found in 9.3%. Approach specific complications including transient deficits were 65%, mostly supraorbital dysesthesia and facial nerve palsy. These at last follow-up had completely resolved in only 48%, improved in 8.3% and remained permanent in 34.5%. Further CSF leaks in 8.6%, orbital roof fractures and isolated other were observed. Intra- or postoperative medical adverse events were 1.6%.
Conclusions: The supraorbital approach in meningiomas of the anterior skull base carries a significant risk of approach specific complications and neurological injury despite extensive surgical experience. Surprisingly, in a series of 97% grade I and only 3% grade II meningiomas the recurrence rate was high, raising the question whether this approach allows sufficient control of residual tumor.
