Surgical management of midline anterior skull base meningiomas: experience of 30 cases

Abstract

AIM:Midline anterior skull base meningiomas include olfactory groove meningiomas (OGMs), Tuberculum Sellae meningiomas (TSMs), and planum sphenoidale meningiomas (PSMs). The main surgical challenge in treating these lesions is to excise the tumor totally without causing mortality or morbidity. Studying the clinical patterns and the surgical outcomes of these lesions. MATErIAL and METHods:Thirty cases of midline anterior skull base lesions were included in our study. Patients were operated upon by four routes: (i) unilateral subfrontal, (ii) bilateral subfrontal, (iii) frontotemporal approach, and (iv) bifrontal basal interhemispheric. Extent of resection was classified according to the Simpson grading system. The functional outcome of the patients was assessed by comparing the preoperative and the postoperative neurological examination, as well as the Karnofsky performance scale. rEsuLTs:We had 14 OGMs (46.7%), 9 TSMs (30%), and 7 PSMs (23.3%). The most commonly utilized approach was the subfrontal approach (unilateral or bilateral) in 80% of the cases, followed by the pterional approach in 16.6% of the cases. Total removal was achieved in 86.7% of the cases; subtotal excision was achieved in 13.3% of the cases. 41.2% of our cases showed postoperative clinical improvement. We had two mortalities in our study, representing 6.7%. We did not detect any tumor recurrences in our follow up. The median preoperative Karnofsky scale was 85, while the median postoperative Karnofsky scale was 90.CoNCLusIoN: Midline anterior skull base lesions are becoming amenable for total surgical excision with minimal morbidities and mortalities. Most preferred surgical routes are the subfrontal and the pterional approaches.KEywords: Olfactory groove meningiomas, Planum sphenoidale meningiomas, Tuberculum sellae meningiomas, Simpson grade ÖZ AMAÇ: Orta hat anterior kafa kaidesinin menenjiyomları olfaktör oluk menenjiyomları (OOM'ler), tüberkulum sella menenjiyomları (TSM'ler) ve planum sfenoidale menenjiyomları (PSM'leri) içerir. Bu lezyonların tedavisindeki ana cerrahi zorluk tümörün herhangi bir mortalite veya morbiditeye neden olmadan tümüyle eksizyonudur. Bu lezyonların klinik paternleri ve cerrahi sonuçları çalışılmıştır. yÖNTEM ve GErEÇLEr: Çalışmaya otuz orta hat anterior kafa kaidesi lezyonu dahil edilmiştir. Hastalar dört yolla ameliyat edilmiştir: (i) ünilateral subfrontal, (ii) bilateral subfrontal, (iii) frontotemporal yaklaşım ve (iv) bifrontal bazal interhemisferik. Rezeksiyon kapsamı Simpson derecelendirme sistemine göre sınıflandırılmıştır. Hastaların işlevsel sonucu preoperatif ve postoperatif nörolojik muayenenin ve Karnofsky performans ölçeği sonuçlarının karşılaştırılmasıyla değerlendirilmiştir.BuLGuLAr: 14 OOM (%46,7), 9 TSM (%30) ve 7 PSM (%23,3) mevcuttur. En sık kullanılan yaklaşım, olguların %80'inde kullanılan subfrontal yaklaşım (unilateral veya bilateral) olmuş ve bunu olguların %16,6'sında pterional yaklaşım takip etmiştir. Total eksizyon olguların %86,7'sinde ve subtotal eksizyon %13,3'ünde elde ed...

The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas—a meta-analysis

“…For TSM, 44 case series (of which 11 were in eTSA, 29 in mTCA, and 4 in both) were included in the meta-analysis for the different outcomes, including a total of 1444 patients [ 3 , 5 , 8 , 11 – 13 , 15 , 16 , 20 , 21 , 23 , 25 , 29 , 30 , 32 , 34 – 36 , 40 , 41 , 43 , 45 , 47 – 53 , 56 , 58 , 61 – 63 , 65 , 66 , 68 , 69 , 72 , 73 , 77 , 79 , 81 , 82 ]. As for OGM, 25 case series (of which 6 were in eTSA, 18 in mTCA, and 1 in both) were included describing outcomes in 891 patients [ 2 , 4 , 6 , 7 , 17 , 19 , 22 , 24 , 25 , 35 , 37 , 40 , 44 , 47 , 55 , 57 , 60 , 62 , 64 , 67 , 68 , 70 , 75 , 76 , 78 ].

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“…The median follow-up time was 6.0 years based on 35 studies for TSM [ 3 , 5 , 8 , 12 , 13 , 15 , 16 , 21 , 25 , 29 , 30 , 32 , 34 , 36 , 43 , 45 , 47 – 53 , 56 , 61 , 62 , 65 , 66 , 68 , 72 , 73 , 77 , 79 , 81 , 82 ] and 7.0 years based on 20 studies for OGM [ 2 , 4 , 6 , 7 , 17 , 19 , 22 , 24 , 25 , 37 , 44 , 47 , 55 , 57 , 60 , 62 , 67 , 68 , 76 , 78 ]. The modified NOS score varied between three and four of seven among the TSM and OGM case series [ 3 , 5 , 8 , 11 – 13 , 15 , 16 , 20 , 21 , 23 , 25 , 29 , 30 , 32 , 34 – 36 , 40 , 41 , 43 , 45 , 47 – 53 ,…”

“…For TSM, GTR after eTSA was reported in 14 studies [ 8 , 11 – 13 , 16 , 20 , 23 , 29 , 30 , 40 , 43 , 61 , 62 , 79 ] and after mTCA was reported in 31 studies [ 3 , 5 , 11 , 13 , 15 , 21 , 23 , 25 , 29 , 32 , 34 , 36 , 45 , 47 – 49 , 51 – 53 , 56 , 58 , 63 , 65 , 66 , 68 , 69 , 72 , 77 , 79 , 81 , 82 ]. In a fixed effect model, the overall incidence for GTR was not significantly different comparing eTSA (incidence = 83.0%; 95% CI = 76.7–88.0%, p-heterogeneity = 0.74, I 2 = 0%, 221 patients) to mTCA (incidence = 85.8% (95% CI = 83.6–87.9%, p-heterogeneity = 0.07, I 2 : 28.4%, 1223 patients) (p-interaction value = 0.34).…”

“…Visual outcomes were reported in 12 studies for eTSA [ 8 , 12 , 16 , 23 , 29 , 30 , 35 , 40 , 43 , 61 , 62 , 79 ] and 28 studies for mTCA [ 3 , 5 , 13 , 15 , 21 , 23 , 25 , 29 , 32 , 34 , 36 , 47 – 51 , 56 , 63 , 65 , 66 , 68 , 69 , 72 , 73 , 77 , 81 , 82 ] with a total of 1139 patients presenting with visual problems [ 3 , 5 , 8 , 12 , 13 , 15 , 16 , 21 , 23 , 25 , 29 , 30 , 32 , 34 – 36 , 40 , 43 , 47 – 51 , 53 , 56 , 61 – 63 , 65 , 66 , 68 , 69 , 72 , 73 , 77 , 79 , 81 , 82 ]. Postoperative visual improvement was significantly higher for eTSA (incidence = 77.7%; 95% CI = 70.3–83.7%, p-heterogeneity = 0.37, I 2 = 7.90%, 167 patients) than mTCA (incidence = 60.7%; 95% CI = 57.3–64.0, p-heter...…”

Meningioma da Fossa Craniana Anterior Associado a Depressão

“…Zivkovic et al 27 descreveram um caso de uma paciente com depressão, tratada por dois anos e que foi diagnosticado meningioma da convexidade temporal após apresentar crise convulsiva focal. Refaat et al 19 relataram em sua série de 30 casos de meningiomas localizados na linha média da fossa craniana anterior, em que a manifestação clínica mais comum foi cefaleia (70%), seguida de alterações visuais (63%), anosmia (20%), alterações de comportamento (13%) e crises convulsivas (13%). Não foi evidenciada associação entre a localização do tumor, edema peritumoral e sintomas depressivos 4,15 .…”