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

Lucas Serrano Sponton; Florian Oehlschlaegel; Amr Nimer; Eike Schwandt; Martin Glaser; Eleftherios Archavlis; Jens Conrad; Sven Kantelhardt; Ali Ayyad

doi:10.1055/s-0042-1751000

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2023; 84(04): 349-360
DOI: 10.1055/s-0042-1751000

Original Article

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

Authors

Lucas Serrano Sponton‡^*

¹Department of Neurosurgery, Sana Klinikum Offenbach, Offenbach am Main, Germany

²Department of Neurosurgery, Mainz University Medical Centre, Mainz, Germany
Florian Oehlschlaegel‡^*

²Department of Neurosurgery, Mainz University Medical Centre, Mainz, Germany

³Department of Neurosurgery, Helios Amper Clinic, Dachau, Germany, Germany
Amr Nimer

²Department of Neurosurgery, Mainz University Medical Centre, Mainz, Germany

⁴Department of Neurosurgery, Charing Cross Hospital, Imperial College Healthcare, London, United Kingdom
Eike Schwandt

²Department of Neurosurgery, Mainz University Medical Centre, Mainz, Germany
Martin Glaser

²Department of Neurosurgery, Mainz University Medical Centre, Mainz, Germany
Eleftherios Archavlis

²Department of Neurosurgery, Mainz University Medical Centre, Mainz, Germany
Jens Conrad

²Department of Neurosurgery, Mainz University Medical Centre, Mainz, Germany
Sven Kantelhardt

²Department of Neurosurgery, Mainz University Medical Centre, Mainz, Germany
Ali Ayyad

²Department of Neurosurgery, Mainz University Medical Centre, Mainz, Germany

⁵Department of Neurosurgery, Hamad General Hospital, Doha, QATAR

⁶Department of Neurosurgery, Saarland University Medical Centre, Homburg, Germany

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

Full Text

References

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