Abstract | OBJECT: This paper describes a consecutive series of skull base meningiomas resected using an endoscopic endonasal approach through various corridors at a single institution over 7 years. The impact of case selection and experience, the presence of a cortical cuff between the tumor and surrounding vessels, and brain edema on morbidity and rates of gross-total resection (GTR) were examined. METHODS: A retrospective review of a series of 46 skull base meningiomas from a prospective database was conducted. The series of cases were divided by location: olfactory groove (n = 15), tuberculum and planum (n = 20), sellar/cavernous (n = 9) and petroclival (n = 2). Gross-total resection was never intended in the sellar/cavernous tumors, which generally invaded the cavernous sinus. Clinical charts, volumetric imaging, and pathology were reviewed to assess the extent of resection and complications. Cases were divided based on a time point in which surgical technique and case selection improved into Group 1 (surgery prior to June 2008; n = 21) and Group 2 (surgery after June 2008; n = 25) and into those with and without a cortical cuff and with and without brain edema. RESULTS: Improved case selection had the greatest impact on extent of resection. For the entire cohort, rates of GTR went from 38% to 76% (p = 0.02), and for cases in which GTR was the intent, the rates went from 63% to 84% (not significant), which was mostly driven by the planum and tuberculum meningiomas, which went from 75% to 91.7 % (nonsignificant difference). The presence of a cortical cuff and brain edema had no impact on outcomes. There were 3 CSF leaks (6.5%) but all were in Group 1. Hence, CSF leak improved from 14.2% to 0% with surgical experience. Lessons learned for optimal case selection are discussed. CONCLUSIONS: Surgical outcome for endonasal endoscopic resection of skull base meningiomas depends mostly on careful case selection and surgical experience. Imaging criteria such as the presence of a cortical cuff or brain edema are less important.
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Authors | Osaama H Khan, Vijay K Anand, Theodore H Schwartz |
Journal | Neurosurgical focus
(Neurosurg Focus)
Vol. 37
Issue 4
Pg. E7
( 2014)
ISSN: 1092-0684 [Electronic] United States |
PMID | 25465040
(Publication Type: Journal Article)
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Topics |
- Adult
- Brain Edema
(surgery)
- Endoscopy
(methods)
- Female
- Humans
- Magnetic Resonance Imaging
- Male
- Meningeal Neoplasms
(surgery)
- Meningioma
(surgery)
- Middle Aged
- Morbidity
- Nasal Cavity
(surgery)
- Nose
(surgery)
- Postoperative Complications
(mortality, physiopathology)
- Predictive Value of Tests
- Retrospective Studies
- Skull Base
(surgery)
- Treatment Outcome
- Young Adult
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