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.
