Limitations of the endonasal endoscopic approach in treating olfactory groove meningiomas. A systematic review

Abstract

Our updated literature review demonstrates that despite more experience with endoscopic resection and skull base reconstruction, the literature still supports TCA over EEA with respect to the extent of resection and complications. EEA may be an option in selected cases where visual improvement is the main goal of surgery and postoperative anosmia is acceptable to the patient or in medium-sized tumors with existing preoperative anosmia. Nevertheless, based on our results, it seems more prudent at this time to use TCA for the majority of OGMs.

The Endoscopic Endonasal Management of Anterior Skull Base Meningiomas

“…Anterior skull base meningiomas represent a wide cohort of tumors with different location, extension and histotypes, which can be suitable for an EEA in selected cases. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Indeed, as stated by Khan et al, careful case selection and surgical experience are the most relevant prognostic factors in endonasal endoscopic skull base meningioma surgery. [18][19][20][21] Particularly, this approach should be reserved to strictly midline tumors, with no encasement of major vessels.…”

“…The role of endoscopic endonasal approach (EEA) in anterior skull base meningioma surgery has been widely debated in current literature. [1][2][3][4][5][6][7][8][9] Most of these tumors are located intradurally; therefore, their removal through a ventral route requires an osteodural opening with the risk of postoperative cerebrospinal fluid (CSF) leak. [1][2][3][4][5][6][7][8][9] This could suggest that such approach might seem "unnatural" because it does not follow natural surgical corridors and increases the risk of complications; however, many papers have considered that it could give many advantages both for surgeons and for patients.…”

“…[1][2][3][4][5][6][7][8][9] Most of these tumors are located intradurally; therefore, their removal through a ventral route requires an osteodural opening with the risk of postoperative cerebrospinal fluid (CSF) leak. [1][2][3][4][5][6][7][8][9] This could suggest that such approach might seem "unnatural" because it does not follow natural surgical corridors and increases the risk of complications; however, many papers have considered that it could give many advantages both for surgeons and for patients. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Indeed, it adopts a completely extracranial route, which avoids any brain retraction, nerves or arteries crossing and manipulation, it allows an early devascularization, and it gives the possibility to remove the tumor, adopting the arachnoid as cleavage plane, and therefore, reducing the risk of damage by perforating vessels and optochiasmatic feeders.…”

“…[1][2][3][4][5][6][7][8][9] This could suggest that such approach might seem "unnatural" because it does not follow natural surgical corridors and increases the risk of complications; however, many papers have considered that it could give many advantages both for surgeons and for patients. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Indeed, it adopts a completely extracranial route, which avoids any brain retraction, nerves or arteries crossing and manipulation, it allows an early devascularization, and it gives the possibility to remove the tumor, adopting the arachnoid as cleavage plane, and therefore, reducing the risk of damage by perforating vessels and optochiasmatic feeders. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] In literature, many authors have reported their surgical experiences with anterior skull base meningiomas operated on through the EEA, demonstrating its feasibility and safety in selected cases.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Indeed, it adopts a completely extracranial route, which avoids any brain retraction, nerves or arteries crossing and manipulation, it allows an early devascularization, and it gives the possibility to remove the tumor, adopting the arachnoid as cleavage plane, and therefore, reducing the risk of damage by perforating vessels and optochiasmatic feeders. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] In literature, many authors have reported their surgical experiences with anterior skull base meningiomas operated on through the EEA, demonstrating its feasibility and safety in selected cases. 7,8,[14][15][16][17][18] Few meta-analyses or review articles have compared this approach to the transcranial ones.…”