The Endoscopic-Assisted Supraorbital Approach for Resection of Anterior Skull Base Meningiomas: A Large Single-Center Retrospective Surgical Study

Abstract

Objective The endoscopic-assisted supraorbital approach (eSOA) constitutes a minimally invasive strategy for removing anterior skull base meningiomas (ASBM). We present the largest retrospective single-institution and long-term follow-up study of eSOA for ASBM resection, providing further insight regarding indication, surgical considerations, complications, and outcome.

Methods We evaluated data of 176 patients operated on ASBM via the eSOA over 22 years.

Results Sixty-five tuberculum sellae (TS), 36 anterior clinoid (AC), 28 olfactory groove (OG), 27 planum sphenoidale, 11 lesser sphenoid wing, seven optic sheath, and two lateral orbitary roof meningiomas were assessed. Median surgery duration was 3.35 ± 1.42 hours, being significantly longer for OG and AC meningiomas (p <0.05). Complete resection was achieved in 91%. Complications included hyposmia (7.4%), supraorbital hypoesthesia (5.1%), cerebrospinal fluid fistula (5%), orbicularis oculi paresis (2.8%), visual disturbances (2.2%), meningitis (1.7%) and hematoma and wound infection (1.1%). One patient died due to intraoperative carotid injury, other due to pulmonary embolism. Median follow-up was 4.8 years with a tumor recurrence rate of 10.8%. Second surgery was chosen in 12 cases (10 via the previous SOA and two via pterional approach), whereas two patients received radiotherapy and in five patients a wait-and-see strategy was adopted.

Conclusion The eSOA represents an effective option for ASBM resection, enabling high complete resection rates and long-term disease control. Neuroendoscopy is fundamental for improving tumor resection while reducing brain and optic nerve retraction. Potential limitations and prolonged surgical duration may arise from the small craniotomy and reduced maneuverability, especially for large or strongly adherent lesions.

Keywords

meningioma - supraorbital approach - anterior skull base

Notes

Name of the institution where the study was performed: Mainz University Medical Centre, Langenbeck Str. 1, 55131 Mainz, GERMANY.

Code Availability

Not applicable.

Availability of Data and Material

The data that support the findings of this study are available from the corresponding author, L. Serrano Sponton, upon reasonable request.

Ethics Approval

Given that the study collected retrospective data corresponding to regular diagnostic, therapeutical and follow-up procedures at Mainz University Medical Centre (i.e., no additional study-related measures were performed) and data are not passed on to third parties or only in anonymous form (e.g., publication), no ethical concerns were observed by the local ethics committee and no separate patient consent was required. This is regulated in the Rhineland-Palatinate State by the Hospital Law §36, §37.

Authors' Contributions

L.S.S. contributed toward conceptualization, methodology, data collection, and formal statistical analysis, writing the original draft, review, and editing. F.O. worked on methodology, data collection and formal statistical analysis, writing the original draft, review and editing. A.N. contributed toward writing the original draft, grammar revision, review and editing. E.S., M.G., and E.A. did the review and editing. J.C. did the supervision, review, and editing. S.R.K. contributed toward supervision, writing the original draft, review and editing. A.A. did the conceptualization, project administration, supervision, writing the original draft, review and editing.

^* Contributed equally.

Publikationsverlauf

Eingereicht: 17. Februar 2022

Angenommen: 23. Mai 2022

Artikel online veröffentlicht:
29. Juni 2022

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