J Neurol Surg B Skull Base 2025; 86(S 01): S1-S576
DOI: 10.1055/s-0045-1803209
Presentation Abstracts
Podium Presentations
Oral Presentations

Effectiveness of the Extended Transsphenoidal Approach for Anterior Skull Base Meningiomas: A Systematic Review and Meta-analysis

Lucca B. Palavani
1   Max Planck University Center
,
Lucas Mitre
2   Faculty of Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
,
Bernardo Nogueira
3   Serra dos Órgãos University Center, Teresópolis—Rio de Janeiro, Brazil
,
Fabiana Honorato
4   Faculty of Medicine, Universidade Nove de Julho, Bauru—São Paulo, Brazil
,
Márcio Yuri Ferreira Ferreira
5   Lenox Hill, New York, United States
,
Carlos Alexandre
6   Faculty of Medicine, University Ninth of July, São Paulo, Brazil
,
Paulo Victor Ribeiro
7   Department of Medical Genetics, University of São Paulo, São Paulo, Ribeirão Preto, Brazil
,
Isabela Banderali
1   Max Planck University Center
,
Leonardo de Barros Oliveira
8   Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
,
Fernando Gomes
9   Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
,
Gisele Lúcia Canto Gomes
10   Faculty of Medicine, Federal University of Amazonas, Manaus, Amazonas
,
Raphael Bertani
11   Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil
,
José Alberto Landeiro
12   Department of Neurosurgery, Federal Fluminense University, Rio de Janeiro, RJ, Brazil
› Author Affiliations
› Further Information
Also available atMedOne
 

Purpose: Anterior skull base meningiomas can lead to significant symptoms, including mass effect and neuropsychological decline, necessitating surgical resection. The endoscopic extended transnasal approach has emerged as a minimally invasive alternative to craniotomy, offering a means to address these tumors despite challenges posed by the proximity of critical neurovascular structures and the risk of complications such as CSF leaks. This systematic review and meta-analysis evaluate the safety and efficacy of extended transsphenoidal techniques in anterior skull base meningiomas.

Methods: Following PRISMA guidelines and the Cochrane Handbook, a search was conducted in Medline, Embase, Cochrane, and Ovid. Eligible studies included those in English, with patients having anterior skull base meningiomas, and who underwent endoscopic surgical management. Endpoints included CSF leak, length of stay, complications, and mortality. Major complications were permanent, while minor complications were transient. Tumor-related mortality encompassed any mortality due to tumor presentation, procedure, subsequent treatment, and postoperative course.

Results: The analysis included data from 28 studies with a total of 725 patients, having a median age of 54.77 years, and approximately 71% of them were female. The incidence of CSF leaks was 9% (95% CI: 0.06–0.12) ([Fig. 1]), the overall complication rate was 6% (95% CI: 0.00–0.13) ([Fig. 2]), major complications were noted in 21% of cases (95% CI: 0.12–0.30) ([Fig. 3]), and minor complications showed a rate of 6% (95% CI: 0.00–0.13) ([Fig. 4]).

Zoom
Fig. 1 CSF leak rates.
Zoom
Fig. 2 Overall complications.
Zoom
Fig. 3 Major postoperative complications.
Zoom
Fig. 4: Minor postoperative complications.

Conclusion: Despite the complex anatomical challenges and inherent risks, the extended transsphenoidal approach demonstrated a relatively low complication rate and an acceptable length of hospital stay. This method showed significantly lower CSF leak and complication rates compared to previously published studies from the last decade.



Publication History

Article published online:
07 February 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany