gms | German Medical Science

Objective: Keyhole approaches for the skull base are currently under investigation for skull base tumour surgery. A lower complication rate is to be expected with the same successful resection rate. A good visualization of the target is the major aspect of the procedure to achieve a high resection rate and also a low complication rate. Here the endoscope is a second imaging tool for better visualization of the target intraoperatively and detecting remnant tumour tissue. In this study the authors report their current series of procedures in anterior skull base meningiomas, which were operated in an endoscopy assisted microsurgical procedure.

Methods: Between January 2012 and December 2016, 28 patients with anterior skull base meningiomas underwent microsurgical, endoscopy assisted procedures. The procedures were video recorded. The cases were prospectively followed. The surgical technique was carefully analyzed. Special attention was paid to the necessity of switching the operation strategy, complications, surgical radicality, relief of symptoms.

Results: In all cases an adequate visualization of the tumor was possible. So there was no necessity to switch to another approach. The authors detected in 12 of the 28 cases remnant tumor at the end of the microsurgical procedure with angled or 0° scopes following further resection. In 27 cases (96%) a resection Simpson grade 1 was possible and in the postoperative MRI no remaining tumour was visualized after a 6 and 18 months follow-up. In one case there was a deterioration of vision. In one case a recurrence of the meningioma was shown in the 18 months MRI follow-up. No further complications or complaints were reported.

Conclusion: The endoscopy assisted resection of skull base meningiomas has been shown to be safe and successful with a higher possible radicality and only minor complications. Further cases are necessary to analyze the value of the endoscope in skull base procedures and to compare this with other techniques.