Download PDF
J Neurol Surg B Skull Base 2023; 84(01): 038-050
DOI: 10.1055/a-1733-9320
Original Article

Anterior Skull Base Meningioma: Surgical Approach and Complication Avoidance

Bhawan Nangarwal‡   *
1   Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Jaskaran Singh Gosal‡   *
2   Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Kuntal Kanti Das 
1   Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Deepak Khatri
3   Department of Neurosurgery, Lenox-Hill Hospital, New York, New York, United States
,
Kamlesh Bhaisora
1   Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Pawan Kumar Verma
1   Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Jayesh Sardhara
1   Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Anant Mehrotra
1   Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Arun K. Srivastava
1   Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Awadhesh K. Jaiswal
1   Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Sanjay Behari
1   Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Introduction Endoscopic endonasal approach (EEA) and keyhole transcranial approaches (TCAs) are being increasingly used in anterior skull base meningioma (ASBM) surgery.

Objective We compare tumor resection rates and complication profiles of EEA and supraorbital keyhole approach (SOKHA) with conventional TCAs.

Methods Fifty-four patients with ASBM (olfactory groove meningioma [OGM], n = 19 and planum sphenoidale/tuberculum sellae meningioma [PSM/TSM], n = 35) operated at a single center over 7 years were retrospectively analyzed.

Results The overall rate of gross total resection (GTR) was higher in OGM (15/19, 78.9%) than PSM-TSM group (23/35, 65.7%, p = 0.37). GTR rate with OGM was 90% and 75% with TCA and EEA. Death (n = 1) following medical complication (TCA) and cerebrospinal fluid leak requiring re-exploration (n = 2, one each in TCA and EEA) accounted for the major complications in OGM. For the PSM/TSM group, the GTR rates were 73.3% (n = 11/15), 53.8% (n = 7/13), and 71.4% (n = 5/7) with TCA, EEA, and SOKHA, respectively. Seven patients (20%) of PSM-TSM developed major postoperative complications including four deaths (one each in TCA and SOKHA, and two in EEA groups) and three visual deteriorations. Direct and indirect vascular complications were common in lesser invasive approaches to PSM-TSM especially if the tumor has encased intracranial arteries.

Conclusion No single approach is applicable to all ASBMs. TCA is still the best approach to obtain GTR but has tissue trauma-related problems. SOKHA may be a good alternative to TCA in selected PSM-TSMs, while EEA may be an alternate option in some OGMs. A meticulous patient selection is needed to derive reported results of EEA for PSM-TSM.

Keywords

minimally invasive - supraorbital keyhole - endoscopic endonasal - transcranial - skull base approach - anterior skull base meningioma - complications - arterial injury

* Both authors have contributed equally to this work and both be regarded as first authors.




Publication History

Received: 13 May 2021

Accepted: 06 January 2022

Accepted Manuscript online:
10 January 2022

Article published online:
14 February 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O. Tuberculum sellae meningiomas: high route or low route? A series of 51 consecutive cases. Neurosurgery 2008; 62 (03) 556-563 , discussion 556–563
    CrossrefPubMedGoogle Scholar
  • 2 Khan OH, Anand VK, Schwartz TH. Endoscopic endonasal resection of skull base meningiomas: the significance of a “cortical cuff” and brain edema compared with careful case selection and surgical experience in predicting morbidity and extent of resection. Neurosurg Focus 2014; 37 (04) E7
    CrossrefPubMedGoogle Scholar
  • 3 Abbassy M, Woodard TD, Sindwani R, Recinos PF. An overview of anterior skull base meningiomas and the endoscopic endonasal approach. Otolaryngol Clin North Am 2016; 49 (01) 141-152
    CrossrefPubMedGoogle Scholar
  • 4 Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas. World Neurosurg 2012; 77 (5-6): 713-724
    CrossrefPubMedGoogle Scholar
  • 5 Koutourousiou M, Fernandez-Miranda JC, Stefko ST, Wang EW, Snyderman CH, Gardner PA. Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients. J Neurosurg 2014; 120 (06) 1326-1339
    CrossrefPubMedGoogle Scholar
  • 6 Koutourousiou M, Fernandez-Miranda JC, Wang EW, Snyderman CH, Gardner PA. Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients. Neurosurg Focus 2014; 37 (04) E8
    CrossrefPubMedGoogle Scholar
  • 7 Bander ED, Singh H, Ogilvie CB. et al. Endoscopic endonasal versus transcranial approach to tuberculum sellae and planum sphenoidale meningiomas in a similar cohort of patients. J Neurosurg 2018; 128 (01) 40-48
    CrossrefPubMedGoogle Scholar
  • 8 Liu JK, Silva NA, Sevak IA, Eloy JA. Transbasal versus endoscopic endonasal versus combined approaches for olfactory groove meningiomas: importance of approach selection. Neurosurg Focus 2018; 44 (04) E8
    CrossrefPubMedGoogle Scholar
  • 9 Song SW, Kim YH, Kim JW. et al. Outcomes after transcranial and endoscopic endonasal approach for tuberculum meningiomas-a retrospective comparison. World Neurosurg 2018; 109: e434-e445
    CrossrefPubMedGoogle Scholar
  • 10 Zoli M, Guaraldi F, Pasquini E, Frank G, Mazzatenta D. The Endoscopic Endonasal Management of Anterior Skull Base Meningiomas. J Neurol Surg B Skull Base 2018; 79 (4, suppl 4): S300-S310
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Borghei-Razavi H, Truong HQ, Fernandes-Cabral DT. et al. Minimally invasive approaches for anterior skull base meningiomas: supraorbital eyebrow, endoscopic endonasal, or a combination of both? Anatomic study, limitations, and surgical application. World Neurosurg 2018; 112: e666-e674
    CrossrefPubMedGoogle Scholar
  • 12 Ottenhausen M, Rumalla K, Alalade AF. et al. Decision-making algorithm for minimally invasive approaches to anterior skull base meningiomas. Neurosurg Focus 2018; 44 (04) E7
    CrossrefPubMedGoogle Scholar
  • 13 Aftahy AK, Barz M, Krauss P. et al. Midline meningiomas of the anterior skull base: surgical outcomes and a decision-making algorithm for classic skull base approaches. Cancers (Basel) 2020; 12 (11) 3243
    CrossrefPubMedGoogle Scholar
  • 14 Nakamura M, Roser F, Struck M, Vorkapic P, Samii M. Tuberculum sellae meningiomas: clinical outcome considering different surgical approaches. Neurosurgery 2006; 59 (05) 1019-1028 , discussion 1028–1029
    CrossrefPubMedGoogle Scholar
  • 15 Aftahy AK, Barz M, Wagner A. et al. The transbasal approach to the anterior skull base: surgical outcome of a single-centre case series. Sci Rep 2020; 10 (01) 22444
    CrossrefPubMedGoogle Scholar
  • 16 DeMonte F. Surgical treatment of anterior basal meningiomas. J Neurooncol 1996; 29 (03) 239-248
    CrossrefPubMedGoogle Scholar
  • 17 Hentschel SJ, DeMonte F. Olfactory groove meningiomas. Neurosurg Focus 2003; 14 (06) e4
    CrossrefPubMedGoogle Scholar
  • 18 Xu M, Xu J, Huang X, Chen D, Chen M, Zhong P. Small extended bifrontal approach for midline anterior skull base meningiomas: our experience with 54 consecutive patients. World Neurosurg 2019; 125: e35-e43
    CrossrefPubMedGoogle Scholar
  • 19 Mortazavi MM, Brito da Silva H, Ferreira Jr M, Barber JK, Pridgeon JS, Sekhar LN. Planum sphenoidale and tuberculum sellae meningiomas: operative nuances of a modern surgical technique with outcome and proposal of a new classification system. World Neurosurg 2016; 86: 270-286
    CrossrefPubMedGoogle Scholar
  • 20 Khanapure K, Joshi KC, Jagannatha AT. et al. Supraorbital craniotomy for large anterior skull base meningiomas: a technical note. Asian J Neurosurg 2019; 14 (03) 767-772
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Khan DZ, Muskens IS, Mekary RA. et al. The endoscope-assisted supraorbital “keyhole” approach for anterior skull base meningiomas: an updated meta-analysis. Acta Neurochir (Wien) 2021; 163 (03) 661-676
    CrossrefPubMedGoogle Scholar
  • 22 Ruggeri AG, Cappelletti M, Fazzolari B, Marotta N, Delfini R. Frontobasal midline meningiomas: is it right to shed doubt on the transcranial approaches? Updates and review of the literature. World Neurosurg 2016; 88: 374-382
    CrossrefPubMedGoogle Scholar
  • 23 Das KK, Gosal JS, Sharma P. et al. Falcine meningiomas: analysis of the impact of radiologic tumor extensions and proposal of a modified preoperative radiologic classification scheme. World Neurosurg 2017; 104: 248-258
    CrossrefPubMedGoogle Scholar
  • 24 Ung TH, Yang A, Aref M, Folzenlogen Z, Ramakrishnan V, Youssef AS. Preservation of olfaction in anterior midline skull base meningiomas: a comprehensive approach. Acta Neurochir (Wien) 2019; 161 (04) 729-735
    CrossrefPubMedGoogle Scholar
  • 25 Liu JK, Christiano LD, Patel SK, Tubbs RS, Eloy JA. Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach. Neurosurg Focus 2011; 30 (05) E2
    CrossrefPubMedGoogle Scholar
  • 26 Khan OH, Krischek B, Holliman D. et al. Pure endoscopic expanded endonasal approach for olfactory groove and tuberculum sellae meningiomas. J Clin Neurosci 2014; 21 (06) 927-933
    CrossrefPubMedGoogle Scholar
  • 27 Zada G, Du R, Laws Jr ER. Defining the “edge of the envelope”: patient selection in treating complex sellar-based neoplasms via transsphenoidal versus open craniotomy. J Neurosurg 2011; 114 (02) 286-300
    CrossrefPubMedGoogle Scholar
  • 28 Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 2005; 57 (4, Suppl): discussion 242–255 242-255
    PubMedGoogle Scholar
  • 29 Banu MA, Mehta A, Ottenhausen M. et al. Endoscope-assisted endonasal versus supraorbital keyhole resection of olfactory groove meningiomas: comparison and combination of 2 minimally invasive approaches. J Neurosurg 2016; 124 (03) 605-620
    CrossrefPubMedGoogle Scholar
  • 30 Schroeder HWS. Indications and limitations of the endoscopic endonasal approach for anterior cranial base meningiomas. World Neurosurg 2014; 82 (6, Suppl): S81-S85
    CrossrefPubMedGoogle Scholar
  • 31 Bernat A-L, Priola SM, Elsawy A. et al. Recurrence of anterior skull base meningiomas after endoscopic endonasal resection: 10 years' experience in a series of 52 endoscopic and transcranial cases. World Neurosurg 2018; 120: e107-e113
    CrossrefPubMedGoogle Scholar
  • 32 Kong D-S, Hong C-K, Hong SD. et al. Selection of endoscopic or transcranial surgery for tuberculum sellae meningiomas according to specific anatomical features: a retrospective multicenter analysis (KOSEN-002). J Neurosurg 2018; 130 (03) 838-847
    CrossrefPubMedGoogle Scholar
  • 33 Van Gompel JJ, Frank G, Pasquini E, Zoli M, Hoover J, Lanzino G. Expanded endonasal endoscopic resection of anterior fossa meningiomas: report of 13 cases and meta-analysis of the literature. Neurosurg Focus 2011; 30 (05) E15
    CrossrefPubMedGoogle Scholar
  • 34 de Divitiis E, Cavallo LM, Esposito F, Stella L, Messina A. Extended endoscopic transsphenoidal approach for tuberculum sellae meningiomas. Neurosurgery 2007; 61 (5, suppl 2): discussion 237–238 229-237
    PubMedGoogle Scholar
  • 35 de Divitiis E, Cavallo LM, Cappabianca P, Esposito F. Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors: part 2. Neurosurgery 2007; 60 (01) 46-58 , discussion 58–59
    CrossrefPubMedGoogle Scholar
  • 36 Bassiouni H, Asgari S, Stolke D. Olfactory groove meningiomas: functional outcome in a series treated microsurgically. Acta Neurochir (Wien) 2007; 149 (02) 109-121 , discussion 121
    CrossrefPubMedGoogle Scholar
  • 37 Jang W-Y, Jung S, Jung T-Y, Moon K-S, Kim I-Y. Preservation of olfaction in surgery of olfactory groove meningiomas. Clin Neurol Neurosurg 2013; 115 (08) 1288-1292
    CrossrefPubMedGoogle Scholar
  • 38 de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O, Esposito I. Endoscopic transnasal resection of anterior cranial fossa meningiomas. Neurosurg Focus 2008; 25 (06) E8
    CrossrefPubMedGoogle Scholar
  • 39 de Almeida JR, Carvalho F, Vaz Guimaraes Filho F. et al. Comparison of endoscopic endonasal and bifrontal craniotomy approaches for olfactory groove meningiomas: a matched pair analysis of outcomes and frontal lobe changes on MRI. J Clin Neurosci 2015; 22 (11) 1733-1741
    CrossrefPubMedGoogle Scholar
  • 40 Gandhoke GS, Pease M, Smith KJ, Sekula Jr RF. Supraorbital versus endoscopic endonasal approaches for olfactory groove meningiomas: a cost-minimization study. World Neurosurg 2017; 105: 126-136
    CrossrefPubMedGoogle Scholar
  • 41 Gardner PA, Vescan A, de Almeida JR. et al. Endoscopic endonasal approach for olfactory groove meningiomas. In: Kassam AB, Gardner PA. eds. Progress in Neurological Surgery: Basel. KARGER AG; 2012: 76-86
    Google Scholar
  • 42 Shetty SR, Ruiz-Treviño AS, Omay SB. et al. Limitations of the endonasal endoscopic approach in treating olfactory groove meningiomas. A systematic review. Acta Neurochir (Wien) 2017; 159 (10) 1875-1885
    CrossrefPubMedGoogle Scholar
  • 43 Muskens IS, Briceno V, Ouwehand TL. et al. The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas-a meta-analysis. Acta Neurochir (Wien) 2018; 160 (01) 59-75
    CrossrefPubMedGoogle Scholar
  • 44 Soldà F, Wharram B, De Ieso PB, Bonner J, Ashley S, Brada M. Long-term efficacy of fractionated radiotherapy for benign meningiomas. Radiother Oncol 2013; 109 (02) 330-334
    CrossrefPubMedGoogle Scholar
  • 45 Combs SE, Farzin M, Boehmer J. et al. Clinical outcome after high-precision radiotherapy for skull base meningiomas: pooled data from three large German centers for radiation oncology. Radiother Oncol 2018; 127 (02) 274-279
    CrossrefPubMedGoogle Scholar
  • 46 Mathiesen T, Pettersson-Segerlind J, Kihlström L, Ulfarsson E. Meningiomas engaging major venous sinuses. World Neurosurg 2014; 81 (01) 116-124
    CrossrefPubMedGoogle Scholar