Artikel
Resection of skull base meningiomas with endoscopic assistance – experience in 44 cases
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Many skull base meningiomas can be successfully resected using standard skull base approaches through the frontolateral, pterional or retrosigmoid route. However, tumors may also involve blind corners of the operative field, which do not always lie in the line of sight of the microscope. Additional visualization with an endoscope may enable an enhanced view of possible remnant tumors. We report our experience of endoscopic assisted surgery in selected skull base meningiomas.
Method: Patients were operated through the frontolateral, pterional, or lateral suboccipital approach using microsurgical technique. In 44 patients, the endoscope was used additionally (0°, 30° and 45° angled view) in order to evaluate, whether any tumor remnants could be identified in blind spots although the microscopic view assumed complete resection of the tumor.
Results: There were 389 patients with skull base meningiomas surgically treated between January 2006 and August 2015. 95 meningiomas were located in the anterior fossa, 87 meningiomas at the sphenoid wing, 32 meninigiomas at the temporal base and 175 meningiomas in the posterior fossa. Among 44 patients, who underwent endoscopic assisted microsurgery, there were 14 tuberculum sellae meningiomas, 12 planum sphenoidale meningiomas, 8 sphenoid wing meningiomas, 6 meningiomas of the posterior fossa and 4 olfactory groove meningiomas. Total tumor resection was achieved in all patients (Simpson grade I and II). In 19 patients (43,2%) tumor remnants not visualized under the microscope were detected with the endoscope. Tumor remnants were removed under endoscopic guidance. For meningiomas involving the anterior optic system, the application of the endoscope was beneficial in order to visualize the area underneath the ipsilateral optic nerve or the optic canal. An enhanced view of the olfactory groove could be achieved with the endoscope in olfactory groove meningiomas. In posterior fossa meningiomas operated through the retrosigmoid approach, enhanced visualization of the internal auditory canal, Meckel’s cave and the area behind the jugular tubercle was beneficial. There was no complication directly related to the endoscopic procedure.
Conclusions: Additional endoscopic visualization during microsurgical resection of skull base meningiomas allowed identification of otherwise microscopically dismissed tumor remnants behind bony and dural anatomical obstacles. Endoscopic assisted surgery enhanced radicality of tumor resection in these cases.