Key Hole Approaches to Giant Anterior Fossa Meningiomas

Based on the location and size of anterior fossa meningiomas, there are a multitude of potential approaches and philosophies to surgical resection. This presentation explores the implementation of keyhole approaches to large and difficult anterior fossa meningiomas and explores decision-making in tailoring a keyhole to specific meningioma sub-locations. Comparison between the use of endoscopy as a sole resection strategy versus endoscopic assistance will also be explored.

This presentation will explore the author’s personal case series of keyhole approaches as applied to anterior fossa meningiomas. A retrospective review of the author’s keyhole meningioma series was conducted, analyzing pathology, approaches and results. 49 keyhole approaches for anterior fossa meningioma resections were conducted. Nineteen of the 49 meningiomas were sized above 6cm and termed giant meningiomas. The supraorbital approach was used in 42 patients, the mini-pterional approach was used in 2 patients, and an extended endonasal approach was used in 5 patients. Gross total resection was achieved in 45 of 49 patients and near-total resection was achieved in 4 patients. Surgical videos and cases will be presented as illustrative examples.

Conclusion: Keyhole approaches to meningioma surgery are a viable operative strategy with a potential for excellent oncological results.

Publication History

Article published online:
07 February 2025