Endoscopic transnasal resection of anterior cranial fossa meningiomas

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The extended transnasal approach, a recent surgical advancements for the ventral skull base, allows excellent midline access to and visibility of the anterior cranial fossa, which was previously thought to be approachable only via a transcranial route. The extended transnasal approach allows early decompression of the optic canals, obviates the need for brain retraction, and reduces neurovascular manipulation.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Between 2004 and 2007, 11 consecutive patients underwent transnasal resection of anterior cranial fossa meningiomas—4 olfactory groove (OGM) and 7 tuberculum sellae (TSM) meningiomas. Age at surgery, sex, symptoms, and imaging studies were reviewed. Tumor size and tumor extension were estimated, and the anteroposterior, vertical, and horizontal diameters were measred on MR images. Medical records, surgical complications, and outcomes of the patients were collected.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A gross-total removal of the lesion was achieved in 10 patients (91%), and in 1 patient with a TSM only a near-total (&gt; 90%) resection was possible. Four patients with preoperative visual function defect had a complete recovery, whereas 3 patients experienced a transient worsening of vision, fully recovered within few days. In 3 patients (2 with TSMs and 1 with an OGM), a postoperative CSF leak occurred, requiring a endoscopic surgery for skull base defect repair. Another patient (a case involving a TSM) developed transient diabetes insipidus. The operative time ranged from 6 to 10 hours in the OGM group and from 4.5 to 9 hours in the TSM group. The mean duration of the hospital stay was 13.5 and 10 days in the OGM and TSM groups, respectively. Six patients (3 with OGMs and 3 with TSMs) required a blood transfusion. Surgery-related death occurred in 1 patient with TSM, in whom the tumor was successfully removed.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The technique offers a minimally invasive route to the midline anterior skull base, allowing the surgeon to avoid using brain retraction and reducing manipulation of the large vessels and optic apparatus; hastens postoperative recovery; and improves patient compliance. Further assessment and refinement are required, particularly because of the potential risk of CSF leakage. Other studies and longer follow-up periods are necessary to ascertain the benefits of the technique.</jats:p></jats:sec>

Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach

“…26 The otolaryngologist performs the initial endonasal exposure to the sphenoid sinus using a 4-mm-diameter, 18-cm-long, 30° endoscope (Karl Storz). Although most authors report using a 0° endoscope for the exposure and resection, 7,8,[15][16][17]26,37 we prefer to use a 30° endoscope because of its versatility in providing the same degree of surgical exposure as with a 0° endoscope, but with the benefits of additional angled viewing capabilities around corners, without having to repeatedly exchange the 2 endoscopes. After injecting the nasal septum and the tail and anterosuperior attachment of the middle turbinates with 1% lidocaine with epinephrine (1:100,000 dilution), both middle and inferior turbinates are lateralized using a Goldman elevator.…”

Tetrahedral silicon balloon for endoscopic skull base reconstruction

“…1 The expanded endonasal approach (EEA) and its modifications provide access to the anterior skull base, planum, sphenoid, sella, clivus, cervical spine, and infratemporal fossa via the two nostrils. [2][3][4][5][6][7][8][9] This approach enables endoscopic extradural and intradural tumor resection and skull base reconstruction in a single procedure.…”

Transsphenoidal endoscopic skull base surgery: state of the art and future perspective

“…However, it does require the same microsurgical techniques and skill utilized in a trans-cranial approach and poses a significantly higher challenge in terms of skull base reconstruction and the possibility of postoperative CSF leak and meningitis. De Divitiis et al [ 24 ] achieved GTR in 10 (91%) of 11 patients with anterior fossa meningiomas treated via an extended endoscopic approach, without complications from excessive brain retraction or neurovascular manipulation [ 25 ]. Gardner et al [ 48 ] also described their experience in 35 patients with anterior fossa meningiomas, achieving a gross total or near-total ( > 95%) resection in 83% of patients with olfactory groove and in 92% of patients with tuberculum sella meningiomas.…”