The extended pterional approach allows excellent results for removal of anterior cranial fossa meningiomas

Lynch, José Carlos; Gonçalves, Mariângela Barbi; Pereira, Celestino; Melo, Wladimir; Temponi, Gianni Ferraz

doi:10.1590/0004-282x20160058

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…A study by Lynch et al 11 also reported good outcomes with unilateral pterional craniotomy, with complete excision and visual improvements of 86 and 89%, respectively, while these were 94 and 67%, respectively, in our group. CSF leak was significantly lower (1.6%) in our study compared to 5.2% in the former study.…”

Section: Discussionsupporting

confidence: 69%

“… 8 Hassler and Zentner 9 described pterional approach for these lesions and later popularized by Yasargil. 10 Additionally, frontolateral approach, extended pterional approach 11 12 with lateral orbitotomy and orbitozygomatic osteotomy, interhemispheric approach, 13 14 mini pterional, and more recently supraorbital keyhole approach (microscopic or endoscope assisted) have been tried. 15 Endoscopic endonasal approach is increasingly studied over the past decade.…”

Section: Introductionmentioning

confidence: 99%

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Pterional Approach for Anterior Skull Base Midline Meningiomas against “The More The Merrier” Approach: An Institutional Experience

et al. 2023

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Objective Anterior midline skull base meningiomas involving olfactory groove, planum sphenoidale, and tuberculum sellae were usually managed with bifrontal craniotomy until the dawn of advanced microsurgical techniques. With the emergence of microsurgical techniques, midline meningiomas could be tackled solely from a unilateral pterional approach. We present our experience with pterional approach in managing anterior skull base midline meningiomas, including the technical nuances and outcomes. Methods Fifty-nine patients who underwent excision of anterior skull base midline meningiomas through a unilateral pterional craniotomy between 2015 and 2021 were retrospectively analyzed. The surgical technique and patient outcomes in the context of visual, behavioral, olfaction, and quality of life were evaluated during the follow-up. Results A total of 59 consecutive patients were assessed over an average follow-up period of 26.6 months. Twenty-one (35.5%) patients had planum sphenoidale meningioma. Olfactory groove and tuberculum sellae meningioma groups consist of 19 (32%) patients each. Visual disturbance was the predominant symptom with almost 68% of patients presented with it. A total of 55 (93%) patients had complete excision of the tumor with 40 patients (68%) achieving Simpson grade II excision, and 11 (19%) patients had Simpson grade I excision. Among operated cases, 24 patients (40%) had postoperative edema among which 3 (5%) patients had irritability and 1 patient had diffuse edema requiring postoperative ventilation. Only 15 (24.6%) patients had contusion of the frontal lobe and were managed conservatively. Five patients (50%) with seizures had an association with contusion. Sixty-seven percent of patients had improvements in vision and 15% of patients had a stable vision. Only eight (13%) patients had postoperative focal deficits. Ten percent of patients had new-onset anosmia. The average Karnofsky score was improved. Only two patients had recurrence during follow-up. Conclusion A unilateral pterional craniotomy is a versatile approach for the excision of anterior midline skull base meningioma, even for the larger lesions. The ability of this approach in the visualization of posterior neurovascular structures at the earlier stages of surgery while avoiding the opposite frontal lobe retraction and frontal sinus opening makes this approach more preferable over the other approaches.

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Section: Discussionsupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Pterional Approach for Anterior Skull Base Midline Meningiomas against “The More The Merrier” Approach: An Institutional Experience

et al. 2023

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“…The anterolateral approaches, namely pterional along with its modifications, such as fronto-lateral, mini-pterional, fronto-orbito-zygomatic, extended pterional, and lateral supraorbital craniotomies, are suitable for handling olfactory groove meningiomas either via the subfrontal or transsylvian route [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Midline Skull Base Meningiomas: Transcranial and Endonasal Perspectives

Mastantuoni

Cavallo

Esposito

et al. 2022

Cancers

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Skull base meningiomas have always represented a challenge for neurosurgeons. Despite their histological nature, they may be associated with unfavorable outcomes due to their deep-seated location and the surrounding neurovascular structures. The state of the art of skull base meningiomas accounts for both transcranial, or high, and endonasal, or low, routes. A comprehensive review of the pertinent literature was performed to address the surgical strategies and outcomes of skull base meningioma patients treated through a transcranial approach, an endoscopic endonasal approach (EEA), or both. Three databases (PubMed, Ovid Medline, and Ovid Embase) have been searched. The review of the literature provided 328 papers reporting the surgical, oncological, and clinical results of different approaches for the treatment of skull base meningiomas. The most suitable surgical corridors for olfactory groove, tuberculum sellae, clival and petroclival and cavernous sinus meningiomas have been analyzed. The EEA was proven to be associated with a lower extent of resection rates and better clinical outcomes compared with transcranial corridors, offering the possibility of achieving the so-called maximal safe resection.

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“…Common indications for the pterional approach include parasellar masses, lesions that extend into the cavernous sinus, parasellar lesions around the circle of Willis and optic apparatus, pituitary macroadenomas, and large intracranial meningiomas. 81,115…”

Section: Cranial Approachesmentioning

confidence: 99%

Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches

et al. 2021

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The sellar, suprasellar, and parasellar space contain a vast array of pathologies, including neoplastic, congenital, vascular, inflammatory, and infectious etiologies. Symptoms, if present, include a combination of headache, eye pain, ophthalmoplegia, visual field deficits, cranial neuropathy, and endocrine manifestations. A special focus is paid to key features on CT and MRI that can help in differentiating different pathologies. While most lesions ultimately require histopathologic evaluation, expert knowledge of skull base anatomy in combination with awareness of key imaging features can be useful in limiting the differential diagnosis and guiding management. Surgical techniques, including endoscopic endonasal and transcranial neurosurgical approaches are described in detail.

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The extended pterional approach allows excellent results for removal of anterior cranial fossa meningiomas

Cited by 5 publications

References 27 publications

Pterional Approach for Anterior Skull Base Midline Meningiomas against “The More The Merrier” Approach: An Institutional Experience

Pterional Approach for Anterior Skull Base Midline Meningiomas against “The More The Merrier” Approach: An Institutional Experience

Midline Skull Base Meningiomas: Transcranial and Endonasal Perspectives

Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches

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