gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Frontolateral approach or endonasal approach in case of anterior skull base meningiomas: which approach should be preferred?

Meeting Abstract

  • Stefan Linsler - Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
  • Gerrit Fischer - Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
  • Axel T. Stadie - Universitätskliniken des Saarlandes, Klinik für Neurochirurgie, Homburg/Saar, Deutschland
  • Joachim Oertel - Universitätskliniken des Saarlandes, Neurochirurgische Klinik, Klinik für Neurochirurgie, Homburg/Saar, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.26.05

doi: 10.3205/17dgnc159, urn:nbn:de:0183-17dgnc1593

Published: June 9, 2017

© 2017 Linsler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Keyhole approaches and endonasal endoscopic approaches for the skull base are currently under investigation for tumor surgery. A lower complication rate is to be expected with the same successful resection rate in comparison to endoscopic extended endonasal procedures, which promise to avoid retraction of neurovascular structures. However, the reported results with these techniques are diverging. Here, the authors compare their current series in case of anterior skull base meningiomas resected via an endoscopic endonasal or microsurgical frontolateral keyhole approach.

Methods: Between January 2011 and December 2016 18 patients received microsurgical frontolateral keyhole procedures for tuberculum sellae meningeomas and 11 patients for olfactorius meningiomas. In the same time period 6 patients received endoscopic endonasal procedure for tuberculum sellae meningiomas and 3 patients for olfactorius meningiomas. The cases were prospectively followed (4 months – 4.7 years). The surgical technique was carefully analysed and the endoscopic endonasal technique was compared to microsurgical supraorbital technique. Special attention was paid to necessity to switch the operation strategy, complications, surgical radicality, and recurrences.

Results: In all cases a sufficient visualization of the tumor was possible. In 24 of 29 microsurgical cases an endoscope was used for final additional control of tumor resection. Remnant tumour was visualized with angled optics in 28% of the endoscopic endonasal cases and in 56% of the microsurgical cases. Gross-total-resection was achieved in 77% of endonasal and 89% of transcranial cases. There were one recurrence in follow up. In one case of microsurgical procedure an ischemia occurred in the frontal lobe without any neurological deficit. In endoscopic cases all patients received a lumbar drainage intraoperatively. No persistant CSF fistula occurred with this treatment.

Conclusion: Resection of skull base meningiomas via frontolateral keyhole approach has been shown to be safe and successful with a high radicality and only minor complications. Especially the high risk of CSF fistulas and the more sophisticated endonasal approach can be avoided. Thus, for most anterior skull base meningiomas, we usually prefer microsurgical transcranial approach. Thereby, the application of angled endoscopes is an essential step of surgery resulting in a higher radicality of tumor resection. The use of lumbar drainage and autologous fat graft for skull base closure minimize the risk of CSF fistula.