Abstract
Background Meningiomas of the anterior skull base are attractive tumors for resection via an
endoscopic endonasal route. The use of the vascularized Hadad-Bassagasteguy nasoseptal
flap has dramatically reduced the cerebrospinal fluid (CSF) leak rate—the veritable
Achilles heel of this surgical approach. Benign meningiomas, however, can erode through
the nasal mucosa—the very same mucosa that is used to reconstruct the anterior cranial
fossa floor. The goal of this study was to describe the presence of meningioma invasion
into the mucosa in patients who underwent endoscopic endonasal resection of ventral
skull base meningiomas. The implications of this finding are discussed with respect
to resection, reconstruction, and recurrence.
Patients, Materials, and Methods This is a retrospective review of three patients who underwent endoscopic endonasal
complete resection of ventral skull base meningiomas. Surgically excised tissues were
processed for routine histopathological analysis.
Results A complete resection of the bone, dura, and tumor was performed in all three cases.
Both patients with visual deficits improved. The first patient to undergo endoscopic
surgical resection developed a CSF leak, but the later two patients with larger tumors
did not. Histopathological analysis demonstrated mucosal invasion by World Health
Organization (WHO) grade I meningioma in two of the three cases.
Conclusion Ventral anterior skull base meningiomas can invade through bone into the mucosa.
Because the endoscopic endonasal resection of these meningiomas often requires the
use of a vascularized nasoseptal flap to minimize CSF leak complications, it is possible
that the nasoseptal flap itself may be compromised by tumor tissue. The creation of
the nasoseptal flap should take the findings of this study into consideration to minimize
late recurrence.
Keywords
skull base - meningiomas - nasoseptal flap - mucosa - endoscopic
