Endonasal Endoscopic Approaches for Anterior Skull Base Meningiomas: Evaluation of Potential Benefits on Outcome Compared with Transcranial Approaches

Objective: Identify potential advantages in endonasal surgical aspiration of this kind of lesion, considering several cases from our transcranial series, which could have been treated also by endoscopic route. Study Design: Midline anterior skull base meningiomas have been traditionally treated via transcranial approaches. Recently, the endoscopic endonasal approach has been introduced for the surgical treatment of such lesions. The actual advantages of the latter approach in terms of outcome are not clear yet. Methods: We analyzed a series of 94 patients treated for olfactory groove or tuberculum sellae meningiomas during the past 13 years. We selected 25 cases who had radiological characteristics that suggest resectability by endoscopic route. Inclusion criteria for the use of expanded endoscopic endonasal approaches are: size less than 4 cm; absence of carotid encasement, or cavernous sinus invasion; no optical nerves involvement, absence of optical canal invasion; extension not above the middle orbital line; anterior limits crista galli and frontal sinus; predominant midline location. We took into consideration several parameters regarding the postoperative course of our patients. Results: Transcranial microsurgical approaches are still the first choice for treatment of midline anterior skull base meningiomas because they allow treating lesions with any characteristics. Conclusion: Transcranial route offer a greater chance of complete removal and lower risk of CSF fistula.