Removal of Suprasellar Meningiomas via the Transciliary Supraorbital Approach

Abstract

The study objective is to compare the outcomes of surgeries performed via the transciliary supraorbital approach and traditional lateral supraorbital approach in patients with suprasellar meningiomas. Material and methods. The experimental group included 17 patients (8 males and 9 females aged between 38 and 67 years (mean age 48.7 ± 5.9 years)) with meningotheliomatous meningiomas (size between 15 and 46 mm (mean size 24.5 ± 5.7 mm) that underwent surgery via the transciliary supraorbital approach. All surgeries were performed by one surgeon. The control group included 20 patients (10 males and 10 females) that underwent surgery via the lateral supraorbital approach. These surgeries were also performed by one surgeon. The 2 groups were matched for size and location of meningiomas. We compared the extent of surgery, frequency of complications, severity of cosmetic defects, and other parameters between the groups. Preoperative examination, microsurgical removal of the tumor, anesthesia, and postoperative management were the same in both groups. Results. We observed no differences in the extent of surgery, frequency of complaints, complications, and neurological status between participants in the experimental and control groups. There were no deaths in either group. Patients that underwent surgery via the transciliary supraorbital approach had lower blood loss than those who underwent surgery via the lateral supraorbital approach (145 ± 18 mL vs 186 ± 24 mL). The duration of surgery was also lower in the experimental group than in the control group (145 ± 24 min vs 167 ± 32 min). Cosmetic outcomes were evaluated using the Cosmetic Visual Analogue Scale. Participants in the experimental group had higher score (>90) than controls (2 patients reported scores of 70 and 80). Possible negative effects of the transciliary supraorbital approach include the risk of scarring in the eyebrow area, skin numbness in the frontal area, paralysis of the frontalis muscle, and the need for more accurate preoperative markings using neuronavigation. Conclusion. In general, the therapeutic effect of surgeries via the transciliary supraorbital and lateral supraorbital approaches do not differ. However, the use of the transciliary supraorbital approach allowed smaller incisions (in both skin and dura mater) and smaller trepanation holes (and as a result minimal displacement of brain structures during surgery). It also ensured lower blood loss and duration of surgery and improved the cosmetic effect. The decision on the surgical approach should be based on tumor characteristics with the consideration of patient’s opinion.