Residual and Recurrent Disease Following Endoscopic Endonasal Approach as a Reflection of Anatomic Limitation for the Resection of Midline Anterior Skull Base Meningiomas

2021 ◽  
Author(s):  
Pradeep Setty ◽  
Juan C Fernandez-Miranda ◽  
Eric W Wang ◽  
Carl H Snyderman ◽  
Paul A Gardner
Keyword(s):  
Optic Nerve ◽  
Skull Base ◽  
Retrospective Chart Review ◽  
Residual Tumor ◽  
Average Diameter ◽  
Anterior Skull Base ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Orbital Roof ◽  
Skull Base Meningiomas

Abstract BACKGROUND Endoscopic endonasal approaches (EEAs) to anterior skull base meningiomas have grown in popularity, though anatomic limitations remain unclear. OBJECTIVE To show the anatomic limits of EEA for meningiomas. METHODS Retrospective chart review for all patients that underwent EEA for anterior skull base meningiomas from 2005 to 2014. RESULTS A total of 100 patients averaged follow-up of 46.9 mo (24-100 mo). A total of 35 patients (35%) had olfactory groove, 33 planum sphenoidale (33%), and 32 tuberculum sella (32%) meningiomas. The average diameter was 2.9 cm (0.5-8.1 cm). Vascular encasement was seen in 11 patients (11%) and calcification in 20 (20%). Simpson Grade 1 (SG1) resection was achieved in 64 patients (64%). Only calcification impacted degree of resection (40% SG1, P = .012). The most common residual was on the anterior clinoid dura (11 patients [11%]). Six (6%) had residual superior/lateral to the optic nerve. Residual tumor was adherent to the optic apparatus or arteries in 5 patients (5%) each, and 3 patients (3%) had residual lateral to the mid-orbit. Rates of residual decreased over time. A total of 11 patients (11%) had tumor recurrence (mean of 40 mo): 4 (4%) on the anterior clinoid, 2 (2%) each on the lateral orbital roof, adherent to optic apparatus and superolateral to the optic nerve, and 1 (1%) was at the anterior falx. CONCLUSION Anterior skull base meningiomas can effectively be approached via EEA in most patients; tumors extending to the anterior clinoid, anterior falx, or superolateral to the optic nerve or orbital roof, especially if calcified, may be difficult to reach via EEA.

Minimally Invasive Approaches to Anterior Skull Base Meningiomas

2020 ◽  
Author(s):  
Scott C. Seaman ◽  
Muhammad S. Ali ◽  
Anthony Marincovich ◽  
Luyuan Li ◽  
Jarrett E. Walsh ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Minimally Invasive ◽  
Skull Base ◽  
Retrospective Chart Review ◽  
Anterior Skull Base ◽  
Direct Access ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Skull Base Meningiomas ◽  
Csf Leaks

Abstract Objective Anterior skull base meningiomas include olfactory groove, planum sphenoidale, and tuberculum sellae lesions. Traditionally, standard craniotomy approaches have been used to access meningiomas in these locations. More recently, minimally invasive techniques including supraorbital and endonasal endoscopic approaches have gained favor; however there are limited published series comparing the use of these two techniques for these meningiomas. Using our patent database, we identified patients who underwent these two approaches, and conducted a retrospective chart review to compare outcomes between these two techniques. Methods A total of 32 patients who underwent minimally invasive approaches were identified: 20 supraorbital and 11 endoscopic endonasal. Radiographic images, presenting complaints and outcomes, were analyzed retrospectively. The safety of each approach was evaluated. Results The mean extent of resection through a supraorbital approach was significantly greater than that of the endoscopic endonasal approach, 88.1 vs. 57.9%, respectively (p = 0.016). Overall, preoperative visual acuity and anopsia deficits were more frequent in the endonasal group that persisted postoperatively (visual acuity: p = 0.004; anopsia: p = 0.011). No major complications including cerebrospinal fluid (CSF) leaks or wound-related complications were identified in the supraorbital craniotomy group, while the endonasal group had two CSF leaks requiring lumbar drain placement. Length of stay was shorter in the supraorbital group (3.4 vs. 6.1 days, p < 0.001). Conclusion Anterior skull base meningiomas can be successfully managed by both supraorbital and endoscopic endonasal approaches. Both approaches provide excellent direct access to tumor in carefully selected patients and are safe and efficient, but patient factors and symptoms should dictate the approach selected.

scholarly journals Decision-making algorithm for minimally invasive approaches to anterior skull base meningiomas

2018 ◽  
Vol 44 (4) ◽  
pp. E7 ◽  
Author(s):  
Malte Ottenhausen ◽  
Kavelin Rumalla ◽  
Andrew F. Alalade ◽  
Prakash Nair ◽  
Emanuele La Corte ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Skull Base ◽  
Anterior Skull Base ◽  
Cribriform Plate ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Incision Size ◽  
The Mean ◽  
Skull Base Meningiomas

OBJECTIVEAnterior skull base meningiomas are benign lesions that cause neurological symptoms through mass effect on adjacent neurovascular structures. While traditional transcranial approaches have proven to be effective at removing these tumors, minimally invasive approaches that involve using an endoscope offer the possibility of reducing brain and nerve retraction, minimizing incision size, and speeding patient recovery; however, appropriate case selection and results in large series are lacking.METHODSThe authors developed an algorithm for selecting a supraorbital keyhole minicraniotomy (SKM) for olfactory groove meningiomas or an expanded endoscopic endonasal approach (EEA) for tuberculum sella (TS) or planum sphenoidale (PS) meningiomas based on the presence or absence of olfaction and the anatomical extent of the tumor. Where neither approach is appropriate, a standard transcranial approach is utilized. The authors describe rates of gross-total resection (GTR), olfactory outcomes, and visual outcomes, as well as complications, for 7 subgroups of patients. Exceptions to the algorithm are also discussed.RESULTSThe series of 57 patients harbored 57 anterior skull base meningiomas; the mean tumor volume was 14.7 ± 15.4 cm3 (range 2.2–66.1 cm3), and the mean follow-up duration was 42.2 ± 37.1 months (range 2–144 months). Of 19 patients with olfactory groove meningiomas, 10 had preserved olfaction and underwent SKM, and preservation of olfaction in was seen in 60%. Of 9 patients who presented without olfaction, 8 had cribriform plate invasion and underwent combined SKM and EEA (n = 3), bifrontal craniotomy (n = 3), or EEA (n = 2), and one patient without both olfaction and cribriform plate invasion underwent SKM. GTR was achieved in 94.7%. Of 38 TS/PS meningiomas, 36 of the lesions were treated according to the algorithm. Of these 36 meningiomas, 30 were treated by EEA and 6 by craniotomy. GTR was achieved in 97.2%, with no visual deterioration and one CSF leak that resolved by placement of a lumbar drain. Two patients with tumors that, based on the algorithm, were not amenable to an EEA underwent EEA nonetheless: one had GTR and the other had a residual tumor that was followed and removed via craniotomy 9 years later.CONCLUSIONSUtilizing a simple algorithm aimed at preserving olfaction and vision and based on maximizing use of minimally invasive approaches and selective use of transcranial approaches, the authors found that excellent outcomes can be achieved for anterior skull base meningiomas.

scholarly journals Surgical challenges and outcome of endoscopic endonasal approaches in the management of recurrent pituitary adenomas

2020 ◽  
pp. 77-84
Author(s):  
Ahmed Nageeb Mohamed Taha ◽  
Hosam Shata Mohamed ◽  
Mahmoud Saad Mohamed
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Surgical Approaches ◽  
Pterional Approach ◽  
Endoscopic Endonasal ◽  
Csf Rhinorrhea ◽  
Olfactory Groove ◽  
Effective Removal ◽  
Operative Notes ◽  
Skull Base Meningiomas

Background: Various surgical approaches for the management of midline anterior skull base meningiomas exist in the literature. The main surgeon target is proper selection the appropriate approach that achieves total removal of the lesion without causing morbidity or mortality and facilitates safe effective removal of the tumor. Objectives: To evaluate the role of the extended pterional approach for excision of midline anterior skull base meningiomas as regard the effectiveness, extent of resection and surgical outcome. Patients and methods: This retrospective study involved 23 cases with midline anterior skull base meningiomas resected through the extended pterional approach. Patients' clinical data, operative notes, imaging studies and clinical follow-up data were analyzed and evaluated. Results: Tumors studied were 9 olfactory groove meningiomas, 8 tuberculum Sellae meningiomas, 4 planum sphenoidale meningiomas and 2 diaphragma sellae meningiomas. Gross total resection tumor excision in 15 cases (64.5%), subtotal excision in 5 cases (21.5%) and partial excision in 3 cases (14%). Complications were diabetes insipidus (2 cases 8.6%), CSF rhinorrhea (3 cases 12.9%) and visual deterioration (3 cases 12.9%). We had two cases of mortality. Conclusion: The extended pterional approach allows safe and effective removal of midline anterior skull base meningiomas. It expands the exposure offered by the classic pterional approach and minimizing the necessity for applying fixed brain retraction with good cosmetic outcome and less approach related morbidities in comparison with the extensive skull base approaches.

scholarly journals The Endoscopic Endonasal Management of Anterior Skull Base Meningiomas

2018 ◽  
Vol 79 (S 04) ◽  
pp. S300-S310 ◽  
Author(s):  
Federica Guaraldi ◽  
Ernesto Pasquini ◽  
Giorgio Frank ◽  
Diego Mazzatenta ◽  
Matteo Zoli
Keyword(s):  
Skull Base ◽  
Frontal Sinus ◽  
Anterior Skull Base ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Skull Base Meningioma ◽  
First Choice ◽  
Tuberculum Sellae ◽  
Skull Base Meningiomas

Introduction The endoscopic endonasal approach (EEA) might seem an “unnatural” route for intradural lesions such as meningiomas. The aim of this study is to critically revise our management of anterior skull base meningiomas to consider, in what cases it may be advantageous. Material and Methods Each consecutive case of anterior skull base meningioma operated on through an EEA or combined endoscopic–transcranial approach at our institution, between 2003 and 2017, have been included. Tumors were classified on the basis of their location and intra or extracranial extension. Follow-up consisted of an MRI (magnetic resonance imaging) and a clinical examination 3 months after the surgery and then repeated annually. Results Fifty-seven patients were included. The most common location was the tuberculum sellae (62%), followed by olfactory groove (14%), planum sphenoidale (12%), and frontal sinus (12%). Among these, 65% were intracranial, 7% were extracranial, and 28% both intra and extracranial. Radical removal was achieved in 44 cases (77%). Complications consisted in 10 CSF (cerebrospinal fluid) leaks (17.6%), 1 overpacking (1.7%), and 1 asymptomatic brain ischemia (1.7%). Visual acuity and campimetric deficits improved respectively in 67 and 76% of patients. Recurrence rate was of 14%. Conclusions EEA presents many advantages in selected cases of anterior skull base meningioma. However, it is hampered by the relevant risk of CSF leak. We consider that it could be advantageous for planum/tuberculum sellae tumors. Conversely, for olfactory groove or frontal sinus meningiomas, it can be indicated for tumors with extracranial extension, while its role is still debatable for purely intracranial forms as considering our surgical results, it could be advantageous for midline planum/tuberculum sellae tumors. Conversely, it can be of first choice for olfactory groove or frontal sinus meningiomas with extracranial extension, while its role for purely intracranial forms is still debatable.

scholarly journals Extracranial ligation of ethmoidal arteries before resection of giant olfactory groove or planum sphenoidale meningiomas: 3 illustrative cases with a review of the literature on surgical techniques

2013 ◽  
Vol 35 (6) ◽  
pp. E13 ◽  
Author(s):  
Sunil Manjila ◽  
Efrem M. Cox ◽  
Gabriel A. Smith ◽  
Mark Corriveau ◽  
Nipun Chhabra ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Techniques ◽  
Anterior Skull Base ◽  
Preoperative Embolization ◽  
Imaging Data ◽  
Olfactory Groove ◽  
Surgical Ligation ◽  
Ethmoidal Arteries ◽  
Planum Sphenoidale ◽  
Skull Base Meningiomas

Object There are several surgical techniques for reducing blood loss—open surgical and endoscopic—prior to resection of giant anterior skull base meningiomas, especially when preoperative embolization is risky or not technically feasible. The authors present examples of an institutional experience using surgical ligation of the anterior and posterior ethmoidal arteries producing persistent tumor blush in partially embolized tumors. Methods The authors identified 12 patients who underwent extracranial surgical ligation of ethmoidal arteries through either a transcaruncular or a Lynch approach. Of these, 3 patients had giant olfactory groove or planum sphenoidale meningiomas. After approval from the institution privacy officer, the authors studied the medical records and imaging data of these 3 patients, with special attention to surgical technique and outcome. The variations of ethmoidal artery foramina pertaining to this surgical approach were studied using preserved human skulls from the Hamann-Todd Osteological Collection at the Museum of Natural History, Cleveland, Ohio. Results The extracranial ligation was performed successfully for control of the ethmoidal arteries prior to resection of hypervascular giant anterior skull base meningiomas. The surgical anatomy and landmarks for ethmoidal arteries were reviewed in anthropology specimens and available literature with reference to described surgical techniques. Conclusions Extracranial surgical ligation of anterior, and often posterior, ethmoidal arteries prior to resection of large olfactory groove or planum sphenoidale meningiomas provides a safe and feasible option for control of these vessels prior to either open or endoscopic resection of nonembolized or partially embolized tumors.

Sign in / Sign up

Export Citation Format

Share Document